Rates of Opportunistic Salpingectomy in Urogynecologic Procedures

INTRODUCTION: The Society of Gynecologic Oncology released a recommendation in 2013 for the consideration of salpingectomy at the time of abdominal or pelvic surgery. Bilateral salpingectomies have been shown to reduce ovarian cancer risk while not adversely impacting the safety of hysterectomies when performed concurrently. ACOG defines opportunistic salpingectomy (OS) as “the removal of the fallopian tubes for the primary prevention of ovarian cancer in a woman already undergoing pelvic surgery for another indication.” Risk factors for not performing salpingectomy during hysterectomies performed by urogynecology have been evaluated, but there is a paucity of studies that focus on OS in urogynecologic procedures where hysterectomy is not performed. OBJECTIVE: The purpose of this study is to assess factors associated with successful OS in urogynecologic procedures with and without hysterectomy. METHODS: This is an IRB-approved retrospective cohort study of 400 female patients aged 18 years and older who met inclusion criteria, underwent a urogynecologic procedure between January 1, 2009, and December 31, 2023, and were eligible to undergo an OS. Data was obtained through a review of electronic medical records. Patient age, race, BMI, comorbidity burden as measured by the Charlson Comorbidity Index (CCI), number of prior abdominal surgeries, history of tubal ligation, family history of gynecologic cancer, and menopausal status were collected. The surgical approach (vaginal, laparoscopic, or abdominal), procedure performed, surgeon years of experience, estimated blood loss (EBL), intraoperative complications, procedure length, and presence of a surgical fellow were determined. An OS was considered “successful” when both fallopian tubes were removed in the absence of another indication for removal. Variables were compared using t-test or chi-square tests as appropriate. RESULTS: Of 400 patients, 57% underwent successful OS. Comparing successful to failed cases, the mean age of patients was 57.95 versus 53.22 (p<0.0001), mean BMI was 29.96 versus 28.75 (p=0.33), mean surgeon years of experience was 11.7 versus 10.49 (p=0.08), mean EBL was 239.3 versus 267.31 cc (p=0.15), and mean procedure length was 257.5 versus 260.52 minutes (p=0.75). Race (p=0.23), number of prior abdominal surgeries (p=0.56), history of tubal ligation (p=0.31), family history of gynecologic cancer (p=0.29), surgical approach (p=0.12), intraoperative complications (p=0.78), and the presence of a surgical fellow (p=0.08) did not significantly differ between successful and failed OS groups, whereas CCI (p=0.0006) and type of procedure did (p=0.0001). CONCLUSIONS: In this study, age, comorbidity burden, menopausal status, and type of procedure were associated with successful opportunistic salpingectomy. In cases with successful OS, patients tended to be older, have greater CCI scores, and be postmenopausal. These results may be confounded by the makeup of our population, in which the median age was 56 years and over 70% were postmenopausal. Total hysterectomy with USLS/SSLF and adnexectomy represented the greatest proportion of successful OS, followed by total or supracervical hysterectomy with sacrocolpopexy and adnexectomy. However, these were also the most common procedures in our data set. Further multivariate analyses in a larger study population are intended to better understand factors associated with successful OS in non-hysterectomy procedures in urogynecology (Tables 1 and 2).