A recently published study shows that a system-wide educational program for healthcare providers about the potential of salpingectomy to reduce ovarian cancer risk resulted in a significant increase in the number of patients undergoing the procedure over a three-year time period.
The study, “Experience With Opportunistic Salpingectomy in a Large, Community-Based Health System in the United States,” published in the Journal of Obstetrics and Gynecology, was led by clinicians and researchers at Kaiser Permanente in Northern California.
In 2015, The American College of Obstetrics and Gynecologists issued a statement from its Committee on Gynecologic Practice suggesting that “prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients and that clinical trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer.”
The reasoning behind this preventative recommendation is that the research literature suggests fallopian tubes are the likely origin of a majority of ovarian cancer cases.
About This Study
In an effort to align clinical practice with the committee’s recommendation, researchers aimed to evaluate the outcomes of increasing salpingectomy at the time of hysterectomy for their patients throughout the hospital system, as well as to assess physicians’ attitudes toward the practice and recommendations.
The authors used the hospital’s electronic medical records (EMR) system to identify women 18 years or older undergoing hysterectomy from June 2011 to May 2014 throughout their large integrated healthcare delivery system.
They focused on evaluating the impact of a change in practice recommendation issued by hospital administrators in May 2013 and its impact on the rate of salpingectomies performed. They also looked at data on patients’ blood loss during the procedure, operating time, and patients’ length of stay in the hospital post-procedure.
To properly assess physicians’ attitudes about the practice and recommendations, the researchers administered a survey to the healthcare providers.
After analysis of the EMR data of 12,143 hysterectomies performed during the study period, the procedural findings showed that following the 2013 recommendation there was indeed a statistically significant increase in rate of salpingectomies over the three-year study period.
The increases in the prophylactic procedure by study year were:
- Year 1 to 2: 14.7 to 44.6 percent
- Year 2 to 3: 44.6 to 72.7 percent
Other important findings included:
- 61 percent of laparoscopic hysterectomies were performed with salpingectomy;
- 25 percent of abdominal hysterectomies were performed with salpingectomy;
- 17 percent of vaginal hysterectomies were performed with salpingectomy;
- The average blood loss during the procedure was lower for patients who underwent prophylactic salpingectomy;
- The average procedural time was less for patients who underwent prophylactic salpingectomy;
- There was no statistically significant difference in the length of hospital stay when prophylactic salpingectomy was performed.
The results from the survey of healthcare providers included:
- 86 percent reported offering women removal of the fallopian tubes at the time of hysterectomy;
- 91 percent of the physicians who performed salpingectomy reported no increase in complications;
- Of those providers who performed hysterectomies, their main concerns with the removal of fallopian tubes was on the difficulty accessing the tube (36 percent) and the possibility of “increased complications.”
“Incorporating this procedure into our clinical practice has provided the opportunity for Kaiser Permanente to prevent ovarian cancers, a particularly insidious and lethal cancer with limited screening options,” said Dr. C. Bethan Powell, MD, the study’s senior author and a Kaiser Permanente gynecological oncology surgeon. “We have shown that it is feasible to incorporate this procedure into gynecological practice at a large scale, with no other surgical repercussions.”