Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse.

Autor: Slopnick EA; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA. Emily.slopnick@uhhospitals.org., Sheyn DD; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA., Chapman GC; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA., Mahajan ST; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA., El-Nashar S; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA., Hijaz AK; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2020 Feb; Vol. 31 (2), pp. 373-379. Date of Electronic Publication: 2019 May 21.
DOI: 10.1007/s00192-019-03967-0
Abstrakt: Introduction and Hypothesis: Preoperative counseling about salpingectomy with pelvic surgery is recommended by the American College of Obstetrics and Gynecology for ovarian cancer risk reduction. Our objective was to determine recent practice patterns and patient factors associated with salpingectomy with vaginal hysterectomy (VH) for pelvic organ prolapse (POP) in the USA. We hypothesize that salpingectomy might have become more common in recent years.
Methods: We queried the 2014-2016 National Surgical Quality Improvement Program database for women with a postoperative diagnosis of POP who underwent VH with any combination of pelvic reconstructive procedures. CPT codes do not differentiate salpingectomy from salpingo-oophorectomy, so subjects were stratified by whether concurrent adnexectomy was performed. Chi-squared and multivariate logistic regression analyses were used to evaluate characteristics associated with adnexectomy. Propensity score matching was utilized when evaluating postoperative complication rates.
Results: Of 5,344 women who underwent VH, 2019 (37.8%) had adnexectomy. Adnexectomy rate increased from 34.4% in 2014 to 46.8% in 2016 (p < 0.001). Adnexectomy rates of fellowship-trained urogynecologists and general gynecologists were similar (36.0% vs 38.8%, p = 0.197). On logistic regression analysis, patients more likely to undergo adnexectomy were < 65 years old (OR 0.844, CI 0.75-0.95, p = 0.004), had BMI <30 (OR 0.76, CI 0.68-0.86, p < 0.001), and were non-smokers (OR 0.78, CI 0.64-0.95, p = 0.016). Mean operative time was 17 min longer with adnexectomy (145 vs 128 min, p < 0.001). There were no differences in postoperative complications or reoperation rates between groups.
Conclusions: Adnexectomy during VH for POP is safe and increasingly utilized by gynecology surgeons in the USA.
Databáze: MEDLINE
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