Justifying Bilateral Salpingo-Oophorectomy at Hysterectomy: A Large Retrospective Study

Abstract

<h3>Study Objective</h3> Evaluate proportion of patients with justified bilateral salpingo-oophorectomy (BSO) at hysterectomy based on pathologic diagnosis and determine rate and predictors of avoidable BSO based on preoperative considerations, surgical characteristics and pathologic diagnosis. <h3>Design</h3> Multicenter retrospective analysis. <h3>Setting</h3> 7 Ontario, Canada hospitals (4 academic, 3 community). <h3>Patients or Participants</h3> Patients with concomitant BSO at hysterectomy. <h3>Interventions</h3> All hysterectomies with concomitant BSO from July 2016 to December 2019. Cases by gynecologic oncologists were excluded. <h3>Measurements and Main Results</h3> Demographics, surgical factors, surgeon characteristics and pathologic diagnoses were recorded. BSO was considered justified if pathologic diagnosis was endometriosis or any (pre)malignant diagnosis except for gestational trophoblastic neoplasia or cervical cancer/dysplasia. Criteria for avoidable BSO included: age ˂51 years, preoperative diagnosis of cervical dysplasia or benign diagnosis other than gender dysphoria, risk reduction or premenstrual dysphoric disorder, absence of intraoperative endometriosis and adhesions, and unjustified final pathology. Those with avoidable BSO were compared to patients with at least one criterion for BSO. Multivariate analyses identified factors most strongly associated with avoidable BSO. During the study period, 4191 hysterectomies were completed with 1422 (33.9%) having concomitant BSO. Final pathologic diagnosis justified BSO in 72.8% (1035/1422). The most common pathologic diagnoses were endometrial cancer (439/1422, 30.6%), endometrial hyperplasia (275/1422, 19.3%) and endometriosis (200/1422, 14.1%). The remaining cases were unjustified, with 42/1422 (3%) BSOs deemed avoidable. Compared to cases with at least one criterion for BSO, avoidable BSOs were more frequently completed by generalists (OR 2.01, 95% CI 1.04 to 4.08, p=0.044) and for preoperative diagnoses of abnormal uterine bleeding (OR 3.75, 95% CI 1.96 to 7.43, p<0.001) and/or fibroids (OR 3.26, 95% CI 1.70 to 6.23, p<0.001). <h3>Conclusion</h3> Final pathologic diagnosis justified most BSOs at hysterectomy. Ovarian preservation may have been possible in 3% of women, underscoring the need to standardize practice with respect to BSO among gynecologic surgeons.