Growth in salpingectomy rates in the United States since 2000

Abstract

In 2016, ovarian cancer will account for approximately 5% of cancer-related deaths for women in the United States, with 85% of cases diagnosed at advanced stages.1American Cancer SocietyCancer facts and figures 2016. American Cancer Society, Atlanta2016Google Scholar In recent years, it has been suggested that ovarian cancer results from precancerous lesions arising in the fallopian tube and transferring to the ovary.2Erickson B.K. Conner M.G. Landen C.N. The role of the fallopian tube in the origin of ovarian cancer.Am J Obstet Gynecol. 2013; 209: 409-414Abstract Full Text Full Text PDF PubMed Scopus (196) Google Scholar If the model is correct, removal of the fallopian tubes may effectively reduce a woman’s risk of developing ovarian cancer without the subsequent complications associated with oophorectomy, such as the sequelae of surgical menopause. As a result, in 2013, the Society of Gynecologic Oncology recommended consideration of salpingectomy at the time of any benign pelvic surgery for women at average risk of ovarian cancer.3Society of Gynecologic Oncology. SGO clinical practice statement: salpingectomy for ovarian cancer prevention. 2013. Available at https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention. Accessed June 1, 2016.Google Scholar This new approach to ovarian cancer prevention could substantially increase rates of salpingectomy. This research letter measures recent trends in salpingectomy, and compares them to trends in other pelvic surgeries. International Classification of Diseases, Ninth Revision (ICD-9) codes for general pelvic surgical procedures were identified and grouped into the following procedure categories: hysterectomy (ICD-9 codes 68.3, 68.31, 68.39, 68.4, 68.41, 68.49, 68.5, 68.51, 68.59), oophorectomy (ICD-9 codes 65.3, 65.31, 65.39, 65.5, 65.51, 65.52, 65.53, 65.54), salpingo-oophorectomy (ICD-9 codes 65.4, 65.41, 65.49, 65.6, 65.61, 65.62, 65.63, 65.64), bilateral tubal ligation (ICD-9 codes 66.2, 66.21, 66.22, 66.29, 66.3, 66.31, 66.32, 66.39), and salpingectomy alone (ICD-9 codes 66.5, 66.51, 66.52, 66.6, 66.62, 66.63, 66.69). Although a detailed assessment of surgical indication was not generally possible, pelvic surgeries for clearly nonbenign indications (eg, radical abdominal hysterectomy, radical vaginal hysterectomy, and pelvic evisceration) were not included. Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, the largest public all-payer inpatient claims database, was used to produce national estimates of the annual number of hospitalizations involving each procedure category from 2000 through 2013, the most recently available data. The research did not distinguish between primary procedures and procedures performed concomitantly with other procedures. Nationwide statistics in HCUP incorporate trend weights that allow for accurate longitudinal comparison.4Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed Dec. 17, 2015.Google Scholar The percent change since 2000 was calculated for each procedure category for each year. There was an average of 1,202,711 hospitalizations annually involving these gynecologic procedures from 2000 through 2013. In 2013 there were 77% (27,530 vs 15,512) more salpingectomies performed than in 2000. All other procedure categories trended downward during the same time period (Figure). Furthermore, the majority of the observed increase in salpingectomy rates occurred after 2011, with a 70.73% (27,530 vs 16,124) increase in salpingectomy rates from 2011 through 2013. US rates of salpingectomy have increased considerably since 2011. These findings expand on prior work demonstrating an increase in salpingectomies for benign indications before 2011.5Mikhail E. Salemi J.L. Mogos M.F. Hart S. Saliju H.M. Imudia A.N. National trends of adnexal surgeries at the time of hysterectomy for benign indication, United States, 1998-2011.Am J Obstet Gynecol. 2011; 213: 713.e1-713.e13Abstract Full Text Full Text PDF Scopus (45) Google Scholar A strength of this research is its use of nationally representative data that allow for evaluation of pelvic surgery trends among inpatient hospitalizations. A limitation is that analysis does not provide the indications for procedures or whether they were performed individually or concomitantly with another procedure. Furthermore, many of these procedures are done in the ambulatory setting, for which comparable data are not available. The rise in salpingectomy rates corresponds to the increased acceptance of the model that many ovarian cancers originate in the fallopian tube. Therefore, these findings may reflect physicians’ efforts to reduce ovarian cancer risk by prophylactically removing the fallopian tubes, despite any firm recommendations from physician societies about the indications for such surgery.3Society of Gynecologic Oncology. SGO clinical practice statement: salpingectomy for ovarian cancer prevention. 2013. Available at https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention. Accessed June 1, 2016.Google Scholar