Physician variation in adopting opportunistic salpingectomy at the time of postpartum and interval sterilization for ovarian cancer risk reduction

OBJECTIVES: To examine variation in physician adoption of opportunistic salpingectomy (OS) for patients undergoing tubal sterilization. STUDY DESIGN: Using the Premier Healthcare Database, we identified patients age 18-49 undergoing postpartum or interval sterilization between January 2011-June 2022. Risk-adjusted rate of OS was estimated for each physician-year. Subsequently, we used group-based trajectory models to identify latent groups of physicians following distinct patterns of uptake and examined factors associated with the distinct trajectory patterns. RESULTS: Among 383,338 postpartum sterilizations (7550 physicians), OS increased from 0.1 % in 2011 to 14.3 % in 2022. Two physician adoption trajectories emerged: low (81.9 % of physicians; rate of OS: 0.049 % in 2011 and 6.1 % in 2022) and high (18.1 % of physicians; rate of OS: 0.02 % in 2011 and 55.3 % in 2022) adoption. Likewise, among 136,965 interval sterilizations (3401 physicians), OS rose from 1.4 % in 2011 to 65.9 % in 2022 with nearly equal number of physicians in the low (50.1 %; rate of OS: 0.6 % in 2011 and 25.7 % in 2022) and high (49.9 %; rate of OS: 0.6 % in 2011 and 95.8 % in 2022) adoption groups. Physicians with these distinct trajectories differed significantly in rural/urban location, geographic region, surgical volume, and patient composition. In particular, a 10-percentage-point increase in the proportion of Black patients was associated with lower odds of high adoption for both postpartum (aOR: 0.89, 95 % CI: 0.82-0.96) and interval (aOR: 0.89, 95 % CI: 0.84-0.94) sterilization. CONCLUSIONS: While OS increased over time, a substantial proportion of physicians remained low adopters. Geographic and demographic differences in adoption suggest potential inequitable access.