Variation in Ovarian Conservation in Women Undergoing Hysterectomy for Benign Indications

Perera, Hemashi K. MD; Ananth, Cande V. PhD, MPH; Richards, Catherine A.; Neugut, Alfred I. MD, PhD; Lewin, Sharyn N. MD; Lu, Yu-Shiang MS; Herzog, Thomas J. MD; Hershman, Dawn L. MD; Wright, Jason D. MD

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182887a47
Original Research
Abstract

OBJECTIVE: Emerging data suggest that oophorectomy at the time of hysterectomy for benign indications may increase long-term morbidity and mortality. We performed a population-based analysis to estimate the rates of oophorectomy in women undergoing hysterectomy for benign indications.

METHODS: The Perspective database was used to estimate the rate of ovarian preservation in women aged 40–64 years who underwent hysterectomy for benign indications. Hierarchical mixed-effects regression models were developed to estimate the influence of patient, procedural, physician, and hospital characteristics on ovarian conservation. Between-hospital variation in ovarian preservation also was estimated.

RESULTS: Among 752,045 women, 348,972 (46.4%) underwent bilateral oophorectomy, whereas 403,073 (53.6%) had ovarian conservation. Stratified by age, the rate of ovarian conservation was 74.3% for those younger than 40 years of age; 62.7% for those 40–44 years of age; 40.8% for those 45–49 years of age; 25.2% for those 50–54 years of age; 25.5% for those 55–59 years of age; and 31.0% for those 60–64 years of age. Younger age and more recent year of surgery had the strongest association with ovarian conservation. The observed patient, procedural, physician, and hospital characteristics accounted for only 46% of the total variation in the rate of ovarian conservation; 54% of the variability remained unexplained, suggesting a large amount of intrinsic between-hospital variation in the decision to perform oophorectomy.

CONCLUSION: The rate of ovarian conservation is increasing, particularly among women younger than 50 years old. Although demographic and clinical factors influence the decision to perform oophorectomy, there appears to be substantial between-hospital variation in performance of oophorectomy that remains unexplained by measurable patient, physician, or hospital characteristics.

LEVEL OF EVIDENCE: II

In Brief

The rate of ovarian conservation is increasing; although demographic and clinical factors influence the decision to perform oophorectomy, there is substantial between-hospital variation.

Author Information

Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032; e-mail: jw2459@columbia.edu.

Dr. Hershman is the recipient of a grant from the National Cancer Institute (NCI R01CA134964).

Financial Disclosure Dr. Ananth is a consultant with Bristol Meyers Squibb. The other authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists