Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977-2010.
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ABSTRACT: Objective
To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation.Design
A historical cohort study.Setting
Denmark.Participants
170 000 randomly selected women born 1947-1963 (10 000/year) were followed from 1977 until the end of 2010.Main outcome measures
Effect of hysterectomy with retained fallopian tubes or sterilisation on the risk of salpingectomy. Both were modelled in a Cox proportional hazards model as time-dependent covariates, analysing time to first salpingectomy. End of follow-up period was 31 December 2010.Results
Of 9591 hysterectomies, 6456 (67.3%) had both fallopian tubes retained. HRs for salpingectomy after hysterectomy with retained fallopian tubes and sterilisation were 2.13 (95% 1.88 to 2.42) and 2.42 (2.21 to 2.64), as compared with those for non-hysterectomised and non-sterilised women.Conclusions
Women undergoing hysterectomy with retained fallopian tubes or sterilisation have at least a doubled risk of subsequent salpingectomy. Removal of the fallopian tubes at hysterectomy should therefore be recommended.
SUBMITTER: Guldberg R
PROVIDER: S-EPMC3686168 | biostudies-literature | 2013 Jun
REPOSITORIES: biostudies-literature
Publications
Salpingectomy as standard at hysterectomy? A Danish cohort study, 1977-2010.
Guldberg Rikke R Wehberg Sonja S Skovlund Charlotte Wessel CW Mogensen Ole O Lidegaard Ojvind O
BMJ open 20130620 6
<h4>Objective</h4>To assess if the risk of first-time salpingectomy was affected by prior hysterectomy with retained fallopian tubes and by prior sterilisation.<h4>Design</h4>A historical cohort study.<h4>Setting</h4>Denmark.<h4>Participants</h4>170 000 randomly selected women born 1947-1963 (10 000/year) were followed from 1977 until the end of 2010.<h4>Main outcome measures</h4>Effect of hysterectomy with retained fallopian tubes or sterilisation on the risk of salpingectomy. Both were modelle ...[more]
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Project description:BACKGROUND:The American Congress of Obstetricians and Gynecologists recommends that "the surgeon and patient discuss the potential benefits of the removal of the fallopian tubes during a hysterectomy in women at population risk of ovarian cancer who are not having an oophorectomy," resulting in an increasing rate of salpingectomy at the time of hysterectomy. Rates of salpingectomy are highest for laparoscopic and lowest for vaginal hysterectomy. OBJECTIVE:The primary objective of this study was to determine the feasibility of bilateral salpingectomy at the time of vaginal hysterectomy. Secondary objectives included identification of factors associated with unsuccessful salpingectomy and assessment of its impact on operating time, blood loss, surgical complications, and menopausal symptoms. STUDY DESIGN:This was a multicenter, prospective study of patients undergoing planned vaginal hysterectomy with bilateral salpingectomy. Baseline medical data along with operative findings, operative time, and blood loss for salpingectomy were recorded. Uterine weight and pathology reports for all fallopian tubes were reviewed. Patients completed the Menopause Rating Scale at baseline and at postoperative follow-up. Descriptive analyses were performed to characterize the sample and compare those with successful and unsuccessful completion of planned salpingectomy using Student t test, and ?2 test when appropriate. Questionnaire scores were compared using paired t tests. RESULTS:Among 77 patients offered enrollment, 74 consented (96%), and complete data were available regarding primary outcome for 69 (93%). Mean age was 51 years. Median body mass index was 29.1 kg/m2; median vaginal parity was 2, and 41% were postmenopausal. The indications for hysterectomy included prolapse (78%), heavy menstrual bleeding (20%), and fibroids (11%). When excluding conversions to alternate routes, vaginal salpingectomy was successfully performed in 52/64 (81%) women. Mean operating time for bilateral salpingectomy was 11 (±5.6) minutes, with additional estimated blood loss of 6 (±16.3) mL. There were 8 surgical complications: 3 hemorrhages >500 mL and 5 conversions to alternate routes of surgery, but none of these were due to the salpingectomy. Mean uterine weight was 102 g and there were no malignancies on fallopian tube pathology. Among the 17 patients in whom planned bilateral salpingectomy was not completed, unilateral salpingectomy was performed in 7 patients. Reasons for noncompletion included: tubes high in the pelvis (8), conversion to alternate route for pathology (4), bowel or sidewall adhesions (3), tubes absent (1), and ovarian adhesions (1). Prior adnexal surgery (odds ratio, 2.9; 95% confidence interval, 1.5-5.5; P = .006) and uterine fibroids (odds ratio, 5.8; 95% confidence interval, 1.5-22.5; P = .02) were the only significant factors associated with unsuccessful bilateral salpingectomy. Mean menopause scores improved after successful salpingectomy (12.7 vs 8.6; P < .001). CONCLUSION:Vaginal salpingectomy is feasible in the majority of women undergoing vaginal hysterectomy and increases operating time by 11 minutes and blood loss by 6 mL. Women with prior adnexal surgery or uterine fibroids should be counseled about the possibility that removal may not be feasible.
| S-EPMC6155463 | biostudies-literature
Project description:BACKGROUND:Hysterectomy is a common procedure worldwide and removing healthy fallopian tubes at the time of hysterectomy (opportunistic salpingectomy) to possibly prevent ovarian cancer is increasing in frequency, but still controversial. The experiences and perceptions of women, eligible for the procedure, have not been previously investigated. This study aims to, among women waiting to undergo hysterectomy, explore i) experiences and perceptions of self and healthcare in relation to their elective surgery, ii) perceptions of risks and benefits of hysterectomy, including opportunistic salpingectomy. METHODS:A qualitative study, with focus group discussions including women <?55?years, planned for hysterectomy with ovarian preservation, was performed. Participants were recruited through purposive sampling from six gynecological departments in different parts of Sweden, including both country and university hospitals. Focus group discussions were conducted using a semi-structured interview guide, digitally recorded, transcribed verbatim and analysed by qualitative manifest and latent content analysis. RESULTS:Twenty-one Swedish-speaking women participated. They were 40-53?years of age, reported varying educational levels, countries of birth and indications for hysterectomy. Analysis rendered a theme "Bridging different realities" over four categories: "Being a woman today", "Experiencing and managing body failure", "Navigating the healthcare system" and "Processing continuously until surgery", including 17 subcategories. The participants displayed varying attitudes towards the significance of their uterus in being a woman. A vague understanding of their body was described, leading to fear related to the reasons for surgery as well as surgery itself. Participants described difficulties understanding and recalling information but also stated that insufficient information was provided. Perceptions of the risks and benefits of opportunistic salpingectomy varied. Involvement in decisions regarding the hysterectomy and potential opportunistic salpingectomy was perceived to be dependent on the counselling gynecologist. CONCLUSIONS:The theme Bridging different realities captures the complexity of women deciding on removal of their uterus, and possibly fallopian tubes. It also describes the women's interactions with healthcare and perceived difference between the health professionals and the women's perception of the situation, as viewed by the women. Bridging the different realities faced by patients is required to enable shared decision-making, through sufficient support from healthcare.
| S-EPMC7488533 | biostudies-literature
Project description:When vaccinations with vaccinia against smallpox and Bacillus Calmette-Guérin (BCG) against tuberculosis were phased out in some high-income countries around 1980, the impact on overall mortality was not examined. Recent studies from low-income countries have suggested that these vaccines are associated with mortality reductions, not explained by specific disease protection. We examined whether vaccinia and BCG administered in childhood were associated with long-term mortality reductions in a high-income population.In this case-cohort study, we followed 47?622 schoolchildren from Copenhagen, Denmark, born 1965 to 1976, from their first health examination to 2010. This cohort experienced the phase-out of vaccinia and BCG vaccination programmes.A sub-cohort of 5?316 individuals (699 excluded) was followed for 164?450 person-years (0.2% were lost to follow-up), and 401 deaths due to natural causes (841 deaths in total) occurred in the full cohort. Compared with individuals who had not received vaccinia or BCG, those who had received both vaccinia and BCG had an adjusted hazard ratio (aHR) of 0.54 [95% confidence interval (CI): 0.36-0.81] for mortality due to natural causes of death; those who only received BCG had an aHR of 0.58 (95% CI: 0.39-0.85). Vaccinia and BCG were not associated with any protection against deaths by accidents, suicide or murder, the combined aHR being 0.94 (95% CI: 0.62-1.42).Vaccinia and BCG vaccinations were associated with better long-term survival, which was not explained by specific protection. Vaccines with beneficial non-specific effects may reduce overall mortality even after the target diseases are eradicated.
| S-EPMC5837789 | biostudies-other
Project description:ObjectiveTo examine the short-term effects of salpingectomy during laparoscopic hysterectomy on ovarian reserve when ovarian preservation is planned in view of determining the feasibility of conducting the study on a larger scale.DesignPilot randomized controlled trial.SettingTertiary care, academic medical center.Patient(s)Thirty premenopausal women aged 18 to 45 years undergoing laparoscopic hysterectomy with ovarian preservation for benign indications from April 2012 to September 2012.Intervention(s)Bilateral salpingectomy (n = 15) versus no salpingectomy (n = 15) at the time of laparoscopic hysterectomy with ovarian preservation.Main outcome measure(s)Antimüllerian hormone (AMH) measured preoperatively, at 4 to 6 weeks postoperatively, and at 3 months postoperatively, with operative time and estimated blood loss abstracted from the medical records.Result(s)The mean AMH levels were not statistically significantly different at baseline (2.26 vs. 2.25 ng/ml), 4 to 6 weeks postoperatively (1.03 vs. 1.25 ng/ml), or 3 months postoperatively (1.86 vs. 1.82 ng/ml) among women with salpingectomy versus no salpingectomy, respectively. There was also no statistically significant temporal change in the mean AMH level from baseline to 3 months postoperatively (-0.07 vs. -0.08 ng/ml) between the two groups. No difference in operative time (116 vs. 115 minutes) or estimated blood loss (70 vs. 91 mL) was observed.Conclusion(s)Salpingectomy at the time of laparoscopic hysterectomy with ovarian preservation is a safe procedure that does not appear to have any short-term deleterious effects on ovarian reserve, as measured by AMH level. Conducting a trial of this nature that is adequately powered with long-term follow-up evaluation would be feasible and is required to definitively confirm these results.
| S-EPMC3844119 | biostudies-literature
Project description:Changes in total energy intake have been reported among children and adolescents, but the extent to which the components of total energy-energy density; portion size; and the number of eating/drinking occasions (EO)-drive these changes is unknown.The objective of the current study was to examine the relative contribution to changes in daily total energy.Using cross-sectional nationally representative data from the Nationwide Food Consumption Survey (1977-1978); the Continuing Survey of Food Intake of Individuals (1989-1991); and the National Health and Nutrition Examination Surveys (1994-1998 and 2005-2010) for children and adolescents (aged 2-18 years), changes in total energy (kcal/day) were mathematically decomposed to determine the relative contributions of its three component parts: portion size (g/EO); energy density (kcal/g/EO); and eating/drinking occasions (n). Analyses were completed in 2012.Over the full period, there was an increase in total energy intake (+108 kcal/day) and the number of daily eating/drinking occasions (+1.2). The average portion size per eating/drinking occasion increased between 1977-1978 and 1989-1991, and then dropped by about 85 g/EO between 1989-1991 and 2005-2010. The average energy density per eating/drinking occasion has fluctuated over time, reaching its highest level in 2005-2010 (1.24 kcal/g/EO). The decomposition results show that between 1977-1978 and 2005-2010, changes in the number of eating/drinking occasions per day and portion size per eating occasion were the largest contributors to annualized changes in daily total energy (+19 and -13 kcal/day/year, respectively). Variations in trends were observed for race/ethnicity and parental education subgroups.These findings highlight potentially important intervention targets for reducing energy imbalances in U.S. youth.
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Project description:We examined trends from 1977-2010 in calorie, macronutrient, and food group intake among US adults 55 and older.Cross-sectional time series.A nationally representative sample of the US non-institutionalized population.Older Americans aged ?55 years (n=18,603) from four surveys of dietary intake in 1977-1978, 1989-1991, 1994-1996, and 2005-2010.Dietary intake was assessed using one 24-hour recall. Multivariable linear regression models were used to determine adjusted per capita mean energy and macronutrient intake for each survey year. Interactions were used to examine differences by race/ethnicity, gender, and generation. The top five food group contributors to total calorie intake were identified for each year.Mean total calorie intake increased significantly among older Americans from 1977-2010. Increases in carbohydrate intake (43% to 49% of total calories) were coupled with decreases in total fat intake (from 40% to 34%) while saturated fat (11%) remained constant. Corresponding shifts in food group intake were observed, as red meat intake greatly declined while bread and grain desserts became dominant calorie sources. Calorie intake was significantly higher for whites compared to blacks from 1994-2010. Cohort analysis indicated a shift from decreasing caloric intake with age to relatively stable calorie intake despite increasing age in more recent cohorts.Increases in total calorie intake from 1977-2010, coupled with the finding that more recent generations did not show the expected age-related decrease in caloric consumption, raise concerns about obesity risk among older Americans. Additionally, despite declines across time in total fat intake, saturated fat intake continues to exceed recommendations, and shifts toward increased consumption of grain-based desserts suggest that high discretionary calorie intake by older Americans might make it difficult to meet nutrient requirements while staying within energy needs.
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Project description:PURPOSE:The Danish Work Life Course Cohort (DaWCo) was initiated to study relations between working conditions, health and labour market affiliation using repeated measures of these factors throughout the working life, while accounting for health-differences pre-existing labour market entry. PARTICIPANTS:The cohort encompasses all 15-30-year-old individuals residing in Denmark who entered the labour market during the years 1995-2009 (960?562 individuals and 7?136?188 observations). Data include information on working conditions measured by job exposure matrices linked with registers on health, labour market affiliation and sociodemographics for both the cohort members and their parents. The median age at cohort entry was 20 years and men and women were equally represented. FINDINGS TO DATE:Currently, one study has been published, which found that low job control was associated with increased risk of depressive disorder, independently from indicators of socioeconomic position measured throughout the life-course. The present cohort profile presents data regarding the transitions of cohort members between states of labour market affiliation and data on health services use. All cohort members were employed in their year of entry, but this proportion decreased across the years to 82.4% in the 10th year since cohort entry. The proportion of students peaked at 5?years since cohort entry with 13.9%. FUTURE PLANS:This large prospective cohort offers the possibility to study associations between psychosocial working conditions and rare outcomes and to examine the potential accumulation of effects while accounting for health-differences pre-existing labour market entry. Currently, we are working on analyses on risk of hospital-diagnosed incident depression and disability pensioning. The study is ongoing, and we are planning to extend the study to include the years 2010-2018 and expand the cohort with individuals entering the Danish workforce during these years.
| S-EPMC6887026 | biostudies-literature
Project description:This study directly compares total intrafascial laparoscopic (TAIL) hysterectomy with vaginal (VH) and abdominal (AH) hysterectomy with regard to safety, operating time and time of convalescence. The study is a prospective cohort study (Canadian Task Force classification II-2), including data from patients of a single university-affiliated teaching institution, admitted between 1997 and 2008 for hysterectomy due to benign uterus pathology. Patient data were collected pre-, intra- and postoperatively and complications documented using a standardised data sheet of a Swiss obstetric and gynaecological study group (Arbeitsgemeinschaft Schweizerische Frauenkliniken, Amlikon/Switzerland). Classification of complications (major complications and minor complications) for all three operation techniques, evaluation of surgeons and comparison of operation times and days of hospitalisation were analysed. 3066 patients were included in this study. 993 patients underwent AH, 642 VH and 1,431 total intrafascial hysterectomy. No statistically significant difference for the operation times comparing the three groups can be demonstrated. The mean hospital stay in the TAIL hysterectomy, VH and AH groups is 5.8 +/- 2.4, 8.8 +/- 4.0 and 10.4 +/- 3.9 days, respectively. The postoperative minor complications including infection rates are low in the TAIL hysterectomy group (3.8%) when compared with either the AH group (15.3%) or the VH group (11.2%), respectively. The total of minor complications is statistically significant lower for TAIL hysterectomy as for AH (O.R. 4.52, CI 3.25-6.31) or VH (O.R. 3.16, CI 2.16-4.62). Major haemorrhage with consecutive reoperation is observed statistically significantly more frequent in the AH group when compared to the TAIL hysterectomy group, with an O.R. of 6.13 (CI 3.05-12.62). Overall, major intra- and postoperative complications occur significant more frequently in the AH group (8.6%) when compared to the VH group (3%) and the TAIL hysterectomy group (1.8%). The incidence of major complications applying the standardised TAIL hysterectomy technique is not related to the experience of the surgeons. We conclude that a standardised intrafascial technique of total laparoscopic (TAIL) hysterectomy using an anatomically developed special uterine device is associated with a very low incidence of minor and major intra- and postoperative complications. The direct comparison of complication rates with either vaginal or abdominal hysterectomy favours the total laparoscopic technique, and therefore, this technique can be recommended as a relatively atraumatic procedure. The operation times are comparable for all three techniques without any statistically significant differences. This technique for laparoscopic hysterectomy is shown to be equally safe when applied by experienced gynaecologic surgeons or by residents in training. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s10397-010-0569-0) contains supplementary material, which is available to authorized users.
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Project description:Trisomy 20p is a chromosomal anomaly resulting from whole or partial duplication of the short arm of chromosome 20. It is a rarely reported syndrome and it is estimated that there are only a few cases of this condition worldwide, which hampers the phenotypic characterization of this entity. Conversely, müllerian anomalies include a group of congenital malformations of the uterus, vagina, cervix, and fallopian tubes resulting from alterations in the embryological development of the müllerian ducts. We report a case of pure trisomy 20p diagnosed using array comparative genomic hybridization (CGH) accompanied by a müllerian anomaly in a female patient with abnormal growth pattern, round face, coarse hair, broad nose, long palpebral fissure, epicanthus, and megaureter.
| S-EPMC7457575 | biostudies-literature
Project description:IntroductionPregnancy losses may be associated with increased risks of dementia.MethodsWe conducted a register-based cohort study in 1,243,957 women with ≥1 pregnancy in Denmark in the period 1977-2015. Using Cox regression, we estimated hazard ratios (HRs) comparing risks of dementia in women with and without pregnancy losses.ResultsDuring 21,672,433 person-years of follow-up, 261,279 women experienced a pregnancy loss, and 2188 women were diagnosed with dementia. Stillbirth was associated with an 86% increased risk of dementia overall (HR 1.86, 95% confidence interval [CI] 1.28-2.71). By contrast, miscarriage was not associated with later risk of dementia overall (single miscarriage, HR 0.99, 95% CI 0.87-1.12; recurrent miscarriages, HR 1.06, 95% CI 0.84-1.35). Adjustment for cardiovascular disease, hypertension, and diabetes did not meaningfully alter the association magnitudes.DiscussionStillbirth and dementia may share underlying mechanisms, suggesting that a history of stillbirth should be considered when assessing dementia risk in women.
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