Recent evidence suggests that salpingectomy compared to occlusion sterilization procedures may increase ovarian cancer protection without increasing surgical complications. We started educating providers in our department about this information in late 2013 followed in February 2014 by standardized patient counseling forms that included procedure descriptions, efficacy, complications and potential impact on ovarian cancer incidence. We evaluated trends in sterilization procedures at our institution resulting from these changes.METHODS:
We identified all women who underwent laparoscopic or transcervical sterilizations at our institution for the academic years from July 1, 2011 and June 30, 2015. We excluded women who had more than one sterilization method performed. Pearson's correlation coefficient (R2) was calculated for each method over time.RESULTS:
Two-hundred sterilizations were performed including 67 occlusion, 81 salpingectomy, and 51 transcervical procedures and one excluded mixed procedure. Of the 56 sterilizations in Year 1, occlusion, salpingectomy and transcervical comprised 44.6%, 10.7%, and 44.6% of procedures, respectively. Salpingectomy became the preferred procedure by year 3, comprising 51.1% of sterilizations in Year 3 and 85.3% in Year 4. Of the 41 sterilizations in Year 4, occlusion and transcervical methods each comprised 7.3% of procedures. Method frequency changed linearly over the four-year period for salpingectomy (R2=0.99), occlusion (R2=−0.90) and transcervical (R2=−0.97) procedures.CONCLUSION:
Over time, with changes in clinician education and standardization of patient counseling forms, salpingectomy has become the preferred female sterilization method at our institution. Understanding the relative importance of ovarian cancer protection and efficacy differences on patient choices will be important for directing future policy recommendations.