Opportunistic Salpingectomy Techniques at the Time of Cesarean Delivery: A Retrospective Cohort Study

Abstract

Background: Recent studies have addressed uptake and safety of opportunistic salpingectomy at the time of cesarean delivery. However, there are limited data on outcomes of the surgical techniques used for salpingectomy at cesarean delivery, thus addressing this topic may influence uptake of opportunistic salpingectomy. This study aimed to compare perioperative outcomes of opportunistic salpingectomy techniques used at the time of cesarean delivery. Methods: This was a retrospective cohort study of women undergoing opportunistic salpingectomy for elective sterilization at cesarean delivery between 2011 and 2016 within Kaiser Permanente Northern California. We compared outcomes of salpingectomy performed with a bipolar electrocautery device (LigaSure, Metronic, MD, USA) versus suture ligation. Primary outcomes were surgical and operative room times. Secondary outcomes included estimated blood loss, intraoperative complications, blood transfusions, number of surgeons, length of hospital stay, readmissions and emergency room visits after discharge. We used bivariate and multivariable analyses to identify factors associated with salpingectomy technique. Results: We identified 194 patients with salpingectomies at time of cesarean delivery, of whom 97 (50%) had salpingectomies by bipolar electrocautery and 97 (50%) by suture ligation. In bivariate analysis, salpingectomy by bipolar electrocautery was associated with less estimated blood loss (600 vs. 760 mL, 95%, P = 0.04), shorter operating room times (96 vs. 104 min, P = 0.046) and more surgeons involved (P < 0.001), while the difference in surgery time was not significant (59 vs. 65 min, P = 0.06). Adjusting for statistically significant covariates in multivariable analysis, body mass index and prior abdominal surgery, salpingectomies using bipolar electrocautery were shorter in surgery time than using suture ligation (-10.74 min, confidence interval: -21, -0.49). There were no statistical differences in length of stay, readmission, emergency room visits after discharge, or number of surgeons involved. Two intraoperative complications occurred during salpingectomy and there were two blood transfusions. Conclusions: Salpingectomy was associated with shorter surgery time of 11 min with bipolar electrocautery instead of suture ligation, with no observed differences in postoperative complications. J Clin Gynecol Obstet. 2019;8(3):70-76 doi: https://doi.org/10.14740/jcgo574