8169 National Trends and Outcomes of Surgical Treatment of Tubal Ectopic Pregnancy

Abstract

<h3>Study Objective</h3> To assess the national trends in the use of salpingostomy versus salpingectomy for minimally invasive and open surgical treatment of ectopic pregnancy. <h3>Design</h3> Retrospective cohort <h3>Setting</h3> National Surgical Quality Improvement Program Database. <h3>Patients or Participants</h3> Women treated surgically for tubal ectopic pregnancy between 2014 and 2019. Surgical treatment was further defined as laparoscopic versus open and salpingostomy versus salpingectomy. <h3>Interventions</h3> Current Procedural Terminology codes were used to identify cases. Variables including age, ethnicity, body mass index, comorbidities, blood transfusion, and American Society of Anesthesiologists classification system scores were collected. <h3>Measurements and Main Results</h3> 11, 267 patients were included. 89.3% had a salpingectomy and 10.7% had salpingostomy. Over the years, the rate of salpingectomy increased while that of salpingostomy decreased (86.8%, 89.1% and 91.2%) and (13.1%, 10.9% and 8.8%) every 2 years, p-value <0.001. The rate of laparoscopic treatment increased (from 84.3% to 89%) while that of laparotomy decreased (from 15.7% to 11%) (p-value <0.001). Adverse perioperative outcomes were more likely with salpingostomy compared with salpingectomy (4.6% versus 2.7%, p<0.001). After adjusting for confounders, salpingostomy patients had 79% higher risk for composite adverse outcomes (aRR 1.79, 1.35-2.39) in comparison to those who underwent salpingectomy. These differences were <b>primarily driven</b> by higher rates of readmission and re-operation. <h3>Conclusion</h3> Our study shows a trend away from salpingostomy from 2014-2019. Salpingostomy is associated with worse perioperative outcomes, specifically higher reoperation and readmission rates.