Physician-level variability in adopting opportunistic salpingectomy for ovarian cancer prevention at the time of hysterectomy.
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Opportunistic salpingectomy reduces ovarian cancer risk. To examine heterogeneity among physicians in their adoption of opportunistic salpingectomy in hysterectomy practice, we identified 33,401 non-pregnant patients aged 18 to 49 years in the Premier Healthcare Database who underwent inpatient hysterectomy for benign indications without oophorectomy in 2011-2021 (operated on by 1297 physicians). Opportunistic salpingectomy was measured by procedure codes reflecting bilateral complete removal of fallopian tubes. Even after adjusting for patient age, surgical route, indication, overweight/obesity, smoking status, and co-morbidities, opportunistic salpingectomy use varied widely among physicians. A finite mixture model identified 2 distinct adoption patterns among physicians: 1 exhibiting low adoption (average risk-adjusted rate of opportunistic salpingectomy increased from 0.01% in 2011 to 43.3% in 2021) and the other exhibiting high adoption (10.5% in 2011 to 81.3% in 2021). They accounted for 39.3% and 60.7% of the physicians, respectively. Physicians at teaching hospitals or in the northeast or west were more likely, whereas physicians having more Medicaid patients were less likely, to follow a high-adoption pattern. Physicians' adoption patterns did not differ by hysterectomy volume, hospital size, urban/rural location, or composition of their patients' race/ethnicity and marital status. These results highlight variation among physicians in their level and speed of adopting opportunistic salpingectomy.