Preventing the primary debulking: An educational initiative to increase rates of salpingectomy at cesarean delivery

Objectives: Opportunistic salpingectomy is being performed at higher rates at benign hysterectomy and interval sterilization than at cesarean delivery (CD). The aim of the study was to assess physician practices in offering and performing bilateral salpingectomy (BS) at time of CD after an educational initiative. Methods: We conducted a prospective cohort study of OBGYN physicians who perform cesarean deliveries. We compared outcomes before and after an educational initiative, which comprised of a Grand Rounds presentation on the latest data on BS at CD reviewing feasibility, safety, cost effectiveness and surgical techniques. Chart abstraction assessed patient demographics and rates of BS at CD before and after the intervention. Anonymous physician surveys were also administered before and six months after the intervention. Chi-square or Fisher's exact test were used for categorical variables and T-test or ANOVA for continuous variables. The study was powered to detect a difference of 10% between rates of BS at CD (β=0.20). Results: There were 370 (14% of all CD) sterilization procedures completed at time of CD during the year prior to our intervention, and 168 (12% of all CD) in the subsequent 6 months. Rates of BS at CD increased from 5.1% to 17% (p Download : Download high-res image (197KB) Download : Download full-size image Conclusions: Educational initiatives can increase provider willingness to offer and to complete bilateral salpingectomy at cesarean delivery. Ongoing educational efforts to encourage bilateral salpingectomy may potentially prevent future cases of ovarian cancer.