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Elective Oophorectomy in the United States: Trends and In-Hospital Complications, 1998–2006

Asante, Albert MD, MPH; Whiteman, Maura K. PhD; Kulkarni, Aniket; Cox, Shanna MSPH; Marchbanks, Polly A. PhD; Jamieson, Denise J. MD, MPH

doi: 10.1097/AOG.0b013e3181f5ec9d
Original Research

OBJECTIVES: To examine trends in rates of elective bilateral salpingo-oophorectomy in the United States and to assess the association of perioperative complications with elective bilateral salpingo-oophorectomy.

METHODS: This cross-sectional study uses 1998–2006 data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, a nationally representative sample of inpatient hospitalizations. Analyses were limited to women aged 15 years or older at average risk for ovarian cancer who underwent hysterectomy for a benign gynecologic condition. Tests for trends in elective bilateral salpingo-oophorectomy rates were performed using weighted least squares regression for two time periods, 1998 to 2001 and 2002 to 2006. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for risks of complications associated with elective bilateral salpingo-oophorectomy were estimated using logistic regression.

RESULTS: During the period from 1998 to 2006, 39% of the 2,250,041 women who underwent hysterectomy for benign gynecologic indications had elective bilateral salpingo-oophorectomy (rate, 8.3 per 10,000). The elective bilateral salpingo-oophorectomy rate increased from 7.8 per 10,000 in 1998 to 9.0 per 10,000 in 2001 (P trend <.05) and decreased from 9.0 per 10,000 in 2002 to 7.4 per 10,000 in 2006 (P trend <.05). The largest decline from 2002 to 2006 (20.3%) occurred among those aged 45 to 49 years. Compared with hysterectomy only, elective bilateral salpingo-oophorectomy was associated with an increased risk of complications when performed vaginally (OR 1.12; 95% CI 1.08–1.17) and a decreased risk of complications when performed abdominally (OR 0.91; 95% CI 0.89–0.94) or laparoscopically (OR 0.89; 95% CI 0.83–0.94).

CONCLUSION: Elective bilateral salpingo-oophorectomy rates declined since 2002. However, the risks compared with the benefits of the procedure have not been clearly established. Prospective studies examining elective bilateral salpingo-oophorectomy with and without estrogen therapy are needed to guide practice patterns.

LEVEL OF EVIDENCE: III

Elective oophorectomy rates in the United States increased between 1998 and 2001 and decreased from 2002 to 2006.

From the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia; and Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Corresponding author: Albert Asante, MD, MPH, 69 Jesse Hill Jr Drive SE, Department of Gynecology and Obstetrics, Room 412, Atlanta, GA 30303; e-mail: aasant2@emory.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 The American College of Obstetricians and Gynecologists