Adnexectomy During Vaginal Hysterectomy for Benign Non-Prolapse Indications: A National NSQIP Analysis of Practice Patterns and Perioperative Outcomes.

STUDY

OBJECTIVE

Professional societies recommend opportunistic salpingectomy during vaginal hysterectomy to reduce the risk of ovarian cancer, but it may be technically challenging without uterine prolapse. We examined national patterns, patient and surgical factors, and 30-day perioperative outcomes associated with adnexectomy during vaginal hysterectomy for benign, non-prolapse indications.

DESIGN

Retrospective cohort study. Multivariate logistic regression was used to evaluate characteristics associated with adnexectomy and propensity score matching to evaluate postoperative complication rates.

SETTING

National Surgical Quality Improvement Program (NSQIP) Targeted Hysterectomy database, 2014 to 2020.

PARTICIPANTS

Women who underwent vaginal hysterectomy for benign, non-prolapse indications.

INTERVENTIONS: Vaginal hysterectomy with or without concomitant adnexectomy.

MEASURES AND MAIN

RESULTS

Among 20 490 vaginal hysterectomies, 10 919 (53.3%) included adnexectomy. The most common indications for hysterectomy were abnormal uterine bleeding (35.2%), leiomyoma (19.3%), and endometriosis (6.1%). Most (96%) were performed by obstetrician-gynecologists. Over the study period, the volume of vaginal hysterectomies performed by obstetrician-gynecologists decreased non-significantly (P = .43), whereas the proportion with adnexectomy increased from 39.0% to 61.3% (P <.01). On logistic regression analysis, adnexectomy was more likely in older patients and when the surgeon was a gynecologic oncologist and less likely in patients with obesity, prior pelvic surgery, or low functional status. Median operative time was 8 minutes longer with adnexectomy (89 vs 81 minutes, P <.001). In a propensity score-matched cohort, median length of stay was longer in the no adnexectomy group with no differences in readmission and reoperation rates.

CONCLUSION

More than half of vaginal hysterectomies for benign, non-prolapse indications included adnexectomy with low complication rates, supporting this approach as a safe, minimally invasive option in selected patients. The declining number of vaginal hysterectomies with a rising proportion of adnexectomy, minimal increase in operative time, and low complication rates suggests concentration among surgeons with greater vaginal expertise, which emphasized the importance of ongoing training in vaginal hysterectomy and adnexal surgery.