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Risk of Oophorectomy After Hysterectomy

Casiano, Elizabeth R. MD, MS; Trabuco, Emanuel C. MD, MS; Bharucha, Adil E. MBBS, MD; Weaver, Amy L. MS; Schleck, Cathy D. BS; Melton, L. Joseph III MD; Gebhart, John B. MD, MS

doi: 10.1097/AOG.0b013e31828e89df
Original Research

OBJECTIVE: To compare the risk of subsequent oophorectomy among women who underwent hysterectomy for benign indications and those who did not.

METHODS: Using Rochester Epidemiology Project resources, we compared the risk of oophorectomy through December 31, 2008, among 4,931 women in Olmsted County, Minnesota, who underwent ovary-sparing hysterectomy for benign indications (case group) between 1965 and 2002, with 4,931 age-matched women who did not undergo hysterectomy (referent group). The cumulative incidence of subsequent oophorectomy was estimated by the Kaplan-Meier method, and comparisons were evaluated by Cox proportional hazard models using age as the time scale to allow for complete age adjustment.

RESULTS: The median follow-up times for case group and referent group participants were 19.6 and 19.4 years, respectively. At 10, 20, and 30 years after hysterectomy, the respective cumulative incidences of subsequent oophorectomy were 3.5%, 6.2%, and 9.2% among case group participants and 1.9%, 4.8%, and 7.3% among referent group participants. The overall risk of subsequent oophorectomy among case group participants was significantly higher than among referent group participants (hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.02–1.42; P=.03). Furthermore, among case group participants, the risk of subsequent oophorectomy was significantly higher (HR 2.15, 95% CI 1.51–3.07; P<.001) in women who had both ovaries preserved compared with those who initially had one ovary preserved.

CONCLUSION: The incidence of oophorectomy after hysterectomy is only 9.2% at 30-year follow-up and is only 1.9 percentage points higher than the incidence of oophorectomy in referent women with intact reproductive organs.

LEVEL OF EVIDENCE: II

Thirty years after hysterectomy for benign indications, the cumulative incidence of oophorectomy is low (9.2%), but it is higher than the incidence among women with intact uteri.

Division of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, Texas; and the Divisions of Gynecologic Surgery, Gastroenterology and Hepatology, Biomedical Statistics and Informatics, and Epidemiology, Mayo Clinic, Rochester, Minnesota.

Corresponding author: John Gebhart, MD, MS, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905; e-mail: gebhart.john@mayo.edu.

Supported in part by grant DK 78924, and made possible by the Rochester Epidemiology Project (AG 034676 from the National Institute on Aging), United States Public Health Service.

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

Presented in abstract form at the 37th Annual Society for Gynecologic Surgeons Meeting, April 11-13, 2011, San Antonio, Texas.

The authors thank Shunaha Kim-Fine, MD, for assistance in data collection. Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.