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1.
J Minim Invasive Gynecol ; 25(1): 53-61, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28712794

RESUMEN

STUDY OBJECTIVE: To delineate the use of opportunistic salpingectomy over the study period, to examine factors associated with its use, and to evaluate whether salpingectomy was associated with perioperative complications. DESIGN: A retrospective cross-sectional study (Canadian Task Force classification II-2). SETTING: The Michigan Surgical Quality Collaborative. PATIENTS: Women undergoing ovarian-conserving hysterectomy for benign indications from January 2013 through April 2015. INTERVENTIONS: The primary outcome was the performance of opportunistic salpingectomy with ovarian preservation during benign hysterectomy. The change in the rate of salpingectomy was examined at 4-month intervals to assess a period effect over the study period. Multivariate logistic regression was performed to evaluate independent effects of patient, operative, and period factors. Perioperative outcomes were compared using propensity score matching. MEASUREMENTS AND MAIN RESULTS: There were 10 676 (55.9%) ovarian-conserving hysterectomies among 19 090 benign hysterectomies in the Michigan Surgical Quality Collaborative in the study period. The rate of opportunistic salpingectomy was 45.8% (n = 4890). Rates of opportunistic salpingectomy increased over the study period from 27.5% to 61.6% (p < .001), demonstrating a strong period effect in the consecutive 4-month period analysis. Salpingectomy was more likely with the laparoscopic approach (odds ratio = 3.48; 95% confidence interval, 3.15-3.85) and among women younger than 60 years of age (odds ratio = 1.60; 95% CI, 1.34-1.92). There was substantial variation in salpingectomy across hospital sites, ranging from 3.6% to 79.9%. Salpingectomy was associated with a 12-minute increase in operative time (p < .001), but there were no differences in the estimated blood loss or perioperative complications. CONCLUSION: The rates of salpingectomy increased significantly over the study period. The laparoscopic approach and younger age are associated with an increased probability of salpingectomy. Salpingectomy is not associated with increased blood loss or perioperative complications.


Asunto(s)
Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Histerectomía/estadística & datos numéricos , Tratamientos Conservadores del Órgano/estadística & datos numéricos , Procedimientos Quirúrgicos Profilácticos/estadística & datos numéricos , Salpingectomía/estadística & datos numéricos , Adulto , Estudios Transversales , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/métodos , Neoplasias de las Trompas Uterinas/prevención & control , Femenino , Humanos , Histerectomía/efectos adversos , Histerectomía/métodos , Michigan/epidemiología , Persona de Mediana Edad , Tempo Operativo , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/métodos , Neoplasias Ováricas/prevención & control , Procedimientos Quirúrgicos Profilácticos/efectos adversos , Procedimientos Quirúrgicos Profilácticos/métodos , Estudios Retrospectivos , Factores de Riesgo , Salpingectomía/efectos adversos , Salpingectomía/métodos , Adulto Joven
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