University of North Carolina, Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, Chapel Hill, NC, United States.
University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, NC, United States.
Contraception. 2021 Mar;103(3):203-207. doi: 10.1016/j.contraception.2020.12.001. Epub 2020 Dec 17.
To identify the frequency and characteristics associated with total salpingectomy (TS) versus occlusion or partial salpingectomy (PS) at the time of cesarean delivery.
We performed a retrospective chart review of cesarean deliveries with a concurrent permanent contraception procedure, from July 1, 2014 to June 30, 2019 at 2 hospitals (community hospital and tertiary care academic center) within a single healthcare system. We assessed the proportion of TS versus PS at cesarean, and secondarily compared operative times between the 2 procedures.
We identified 2110 procedures during the 5-year period. Surgeons performed TS in 302 (14%, 95% confidence interval [CI] 13%-16%) cases, and the annual rate varied from 14% to 18% over the study period (p = 0.14). Factors associated with increased likelihood of TS rather than PS included public insurance/self-pay (adjusted odds ratio, aOR 2.8, 95% CI 2.0-4.1), delivery at the community hospital (aOR 4.8, 95% CI 3.0-7.7), parity of 5 or more (aOR 2.2, 95% CI 1.1-4.4), and presence of an obstetrician/gynecologist for cesarean delivery (aOR 2.9, 95% CI 1.6-5.4). The total operative time for TS and PS differed at the academic center (90 vs 68 minutes, p < 0.001) but not at the community hospital (55 vs 54 minutes, p = 0.5).
This study highlights provider and institutional characteristics associated with TS compared to PS at the time of cesarean delivery, which may inform future programs aimed at increasing utilization of TS at cesarean delivery.
Access to TS at the time of cesarean delivery may provide pregnant women with a very effective permanent contraception method at a convenient time of concurrent cesarean. This study identifies patient factors that may influence access to TS as part of obstetrical care.
确定在剖宫产时行输卵管切除术（total salpingectomy，TS）与输卵管阻塞或部分切除术（occlusion or partial salpingectomy，PS）的频率和特点。
我们对 2014 年 7 月 1 日至 2019 年 6 月 30 日期间在同一医疗系统内的 2 家医院（社区医院和三级保健学术中心）进行的剖宫产术同时行永久性避孕手术的病例进行了回顾性图表审查。我们评估了剖宫产术中行 TS 与 PS 的比例，并进一步比较了这两种手术的手术时间。
在 5 年期间，我们共确定了 2110 例手术。在 302 例（14%，95%置信区间 [CI] 13%-16%）患者中，外科医生行 TS，在研究期间，每年行 TS 的比例从 14%到 18%不等（p=0.14）。与行 PS 相比，更倾向于行 TS 的因素包括公共保险/自费（调整优势比 [aOR] 2.8，95%CI 2.0-4.1）、在社区医院分娩（aOR 4.8，95%CI 3.0-7.7）、产次≥5 次（aOR 2.2，95%CI 1.1-4.4）和行剖宫产术的医生为妇产科医生（aOR 2.9，95%CI 1.6-5.4）。在学术中心，行 TS 和 PS 的总手术时间不同（90 分钟 vs. 68 分钟，p<0.001），但在社区医院无差异（55 分钟 vs. 54 分钟，p=0.5）。
本研究强调了与剖宫产时行 PS 相比，行 TS 的提供者和机构特征，这可能为未来旨在增加剖宫产时行 TS 使用率的项目提供信息。
在剖宫产时行 TS 可为孕妇提供一种非常有效的永久性避孕方法，且在同时行剖宫产的便利时间进行。本研究确定了可能影响接受 TS 作为产科护理一部分的患者因素。
