Peer influence on physicians in adopting opportunistic salpingectomy at the time of hysterectomy
Since professional societies recommended counseling patients about opportunistic salpingectomy for ovarian cancer risk reduction, use of opportunistic salpingectomy has increased overall. However, physicians varied in their adoption of this new cancer prevention strategy. To examine peer influence among physicians as a possible factor affecting their adoption of opportunistic salpingectomy at the time of hysterectomy. Using insurance claims data from the Blue Cross Blue Shield Axis database across the United States, we identified female patients aged 18 to 49 who underwent an inpatient hysterectomy in 2019 to 2022. The outcome of interest was opportunistic salpingectomy, defined as complete removal of both (or the remaining) fallopian tubes without concurrent removal of the ovaries. We identified peer relationships among physicians based on whether 2 physicians billed for at least 2 of the same patients among insurance claims in 2017 to 2018. Then for each index physician performing inpatient hysterectomy in the 2019 to 2022 sample, we measured the rate of opportunistic salpingectomy among inpatient hysterectomies performed by all of their peer physicians in 2017 to 2018 (baseline). A multivariable regression analysis was used to examine whether an index physician's baseline exposure to peer physicians' opportunistic salpingectomy rate was associated with the subsequent use of opportunistic salpingectomy among their own patients in 2019 to 2022. Among 3373 patients who underwent inpatient hysterectomy in 2019 to 2022 (operated on by 1528 index physicians), 1871 (55.5%) received opportunistic salpingectomy. The rate of opportunistic salpingectomy was higher among patients whose index physician had exposure to peer physicians with the highest or second highest quartile of baseline opportunistic salpingectomy rate (64.5% and 59.6%, respectively), compared to those with peer physicians in the lowest quartile of baseline opportunistic salpingectomy rate (44.0%) (P<.001). After adjusting for surgical indication, surgical route, and other patient/physician characteristics, having peer physicians in the highest and second highest quartile of baseline opportunistic salpingectomy rate was associated with a 1.99 (95% confidence interval, 1.46-2.71) times and 1.64 (95% confidence interval, 1.21-2.22) times higher odds of receiving opportunistic salpingectomy, respectively. Sharing patients with other physicians who had high utilization of opportunistic salpingectomy was associated with an increased likelihood of an index physician subsequently using opportunistic salpingectomy at the time of hysterectomy. Future efforts to promote opportunistic salpingectomy use may explore the potential benefit of strategies leveraging physician peer influence.
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Salpingectomy for Ovarian Cancer Risk Reduction: Improving Utilization and Informed Decision-MakingGenentech FundingSalpingectomy for Ovarian Cancer Risk Reduction: Improving Utilization and Informed Decision-MakingMerck FundingAmerican College of Obstetricians and Gynecologists FundingNational Comprehensive Cancer Network Foundation Funding