Physician-level variability in adopting opportunistic salpingectomy for ovarian cancer prevention at the time of hysterectomy
Opportunistic salpingectomy reduces ovarian cancer risk. To examine heterogeneity among physicians in their adoption of opportunistic salpingectomy in hysterectomy practice, we identified 33,401 non-pregnant patients aged 18 to 49 years in the Premier Healthcare Database who underwent inpatient hysterectomy for benign indications without oophorectomy in 2011-2021 (operated on by 1297 physicians). Opportunistic salpingectomy was measured by procedure codes reflecting bilateral complete removal of fallopian tubes. Even after adjusting for patient age, surgical route, indication, overweight/obesity, smoking status, and co-morbidities, opportunistic salpingectomy use varied widely among physicians. A finite mixture model identified 2 distinct adoption patterns among physicians: 1 exhibiting low adoption (average risk-adjusted rate of opportunistic salpingectomy increased from 0.01% in 2011 to 43.3% in 2021) and the other exhibiting high adoption (10.5% in 2011 to 81.3% in 2021). They accounted for 39.3% and 60.7% of the physicians, respectively. Physicians at teaching hospitals or in the northeast or west were more likely, whereas physicians having more Medicaid patients were less likely, to follow a high-adoption pattern. Physicians' adoption patterns did not differ by hysterectomy volume, hospital size, urban/rural location, or composition of their patients' race/ethnicity and marital status. These results highlight variation among physicians in their level and speed of adopting opportunistic salpingectomy.