Physician Peer Influence on Salpingectomy Uptake for Tubal Sterilization and Ovarian Cancer Prevention
Importance
Prophylactic removal of the fallopian tubes (opportunistic salpingectomy) in lieu of conventional methods of tubal sterilization helps reduce ovarian cancer risk.
Objective
To examine how peer influence among physicians is associated with opportunistic salpingectomy uptake at the time of postpartum and interval sterilizations.
Design, Setting, and Participants
This retrospective cohort study used insurance claims data from the Blue Cross Blue Shield Axis database. Participants were patients aged 18 to 49 years who underwent a tubal sterilization after childbirth (postpartum sterilization) or unrelated to pregnancy (interval sterilization) from January 2020 to December 2022 and whose operating surgeon did not perform opportunistic salpingectomy at baseline (2017-2019).
Exposures
Applying a Louvain clustering methodology, physician patient-sharing networks were constructed based on their billing of the same patients in claims data at baseline (2017-2019). For surgeons who did not use opportunistic salpingectomy at baseline, the rate of opportunistic salpingectomy use among peer physicians in the same network at baseline was measured.
Main Outcomes and Measures
Opportunistic salpingectomy was defined as removal of both (or the remaining side of) fallopian tubes with preservation of the ovaries.
Results
The overall sample included 4520 patients undergoing postpartum sterilization and 3376 patients undergoing interval sterilization in 2020 to 2022, with 4173 (92.3%) of the postpartum sterilization sample involving a cesarean delivery. Most patients in these 2 samples (3520 patients [77.9%] and 2599 patients [77.0%], respectively) were aged 30 to 49 years. In the postpartum sterilization sample, having peer physicians in the highest (vs lowest) quartile of baseline opportunistic salpingectomy rate was associated with higher odds of receiving opportunistic salpingectomy for postpartum sterilization (13.6% vs 5.6%; adjusted odds ratio [aOR], 2.17; 95% CI, 1.20-3.92; P < .001). In the interval sterilization sample, having peer physicians in the highest (vs lowest) quartile of baseline opportunistic salpingectomy rate was also associated with higher odds of receiving opportunistic salpingectomy for interval sterilization (42.3% vs 19.3%; aOR, 4.16; 95% CI, 1.98-8.77; P < .001).
Conclusions and Relevance
In this retrospective cohort study of postpartum and interval sterilizations, surgeons who previously shared patients with other physicians with high rates of opportunistic salpingectomy use were more likely to adopt opportunistic salpingectomy in their own subsequent practice. These results suggest physician peer influence in salpingectomy uptake.