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Long-term overall and disease-specific mortality associated with benign gynecologic surgery performed at different ages

Gierach, Gretchen L. PhD, MPH1; Pfeiffer, Ruth M. PhD2; Patel, Deesha A. MS1; Black, Amanda PhD, MPH3; Schairer, Catherine PhD2; Gill, Abegail MPH4; Brinton, Louise A. PhD, MPH1; Sherman, Mark E. MD1

doi: 10.1097/GME.0000000000000118
Original Articles
Editorial

Objective: As bilateral salpingo-oophorectomy is frequently performed with hysterectomy for nonmalignant conditions, defining health outcomes associated with benign bilateral salpingo-oophorectomy performed at different ages is critical.

Methods: We assessed mortality risk associated with benign total abdominal hysterectomy or bilateral salpingo-oophorectomy among 52,846 Breast Cancer Detection Demonstration Project follow-up study participants. Surgery and risk factor data were ascertained via baseline interview (1979-1986) and three questionnaires (1987-1998). During follow-up through December 2005 (mean, 22.1 y), 13,734 deaths were identified. We estimated hazard ratios (HRs) and 95% CIs for overall and disease-specific mortality for total abdominal hysterectomy or bilateral salpingo-oophorectomy performed by age 35, 40, 45, 50, or 55 years, compared with not having surgery, using landmark analyses and multivariable Cox regression.

Results: Undergoing bilateral salpingo-oophorectomy by age 35 years was associated with increased mortality risk (HR35 y, 1.20; 95% CI, 1.08-1.34), which decreased with age (HR40 y, 1.12; 95% CI, 1.04-1.21; HR45 y, 1.10; 95% CI, 1.03-1.17). Total abdominal hysterectomy alone performed by age 40 years was associated with increased mortality risk to a lesser extent (HR40 y, 1.08; 95% CI, 1.01-1.15). Analyses based on matched propensity scores related to having gynecologic surgery yielded similar results. Elevated mortality risks were largely attributable to noncancer causes.

Conclusions: Benign gynecologic surgeries among young women are associated with increased mortality risk, which attenuates with age.

From the 1Hormonal and Reproductive Epidemiology Branch, 2Biostatistics Branch, and 3Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD; and 4John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.

Received June 24, 2013; revised and accepted August 28, 2013.

Funding/support: This work was supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health.

Financial disclosure/conflicts of interest: None reported.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.menopause.org).

Address correspondence to: Gretchen L. Gierach, PhD, MPH, Rm 7-E108, MSC 9774, 9609 Medical Center Drive, Bethesda, MD 20892-9774. E-mail: gierachg@mail.nih.gov

© 2014 by The North American Menopause Society.