Removal of normal ovaries in women under age 51 at the time of hysterectomy

Abstract

Despite recommendation for ovarian conservation in low-risk, premenopausal women, bilateral oophorectomy is often performed. The purpose of this study was to investigate factors associated with removal of normal ovaries at the time of hysterectomy for benign indication in women age <51 years. Demographics, indication for surgery, adnexal pathology, and surgical approach were analyzed for hysterectomies from a voluntary, statewide surgical quality collaborative. Cases were excluded if the surgical indication was cancer, pelvic mass, or obstetric, or if age was >50 years. Cases were categorized according to pathology of the adnexal specimen as cancer, benign findings, normal ovary, or no ovarian specimen. Variables including demographics, medical comorbidities, and surgical characteristics were analyzed to identify characteristics associated with oophorectomy at the time of hysterectomy. A logistic regression model was then developed to identify factors independently associated with removal of normal ovaries. A total of 6789 subjects were included. Oophorectomy was performed in 44.2% of women (n = 3002). In all, 23.1% (n = 1565) had normal ovaries on pathology. Incidental ovarian cancer was found in 0.2% (n = 12), and benign pathology was found in 21% (n = 1425). Removal of normal ovaries was less likely when the surgical approach was vaginal (18%) as opposed to laparoscopic (23.1%) or abdominal (26.0%). With adjustment, abdominal (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.43-2.09]) and laparoscopic (OR, 1.27; 95% CI, 1.08-1.50) approach showed significantly higher odds of normal ovary removal compared to vaginal hysterectomy. Age 46-50 years was also significantly associated (OR, 1.78; 95% CI, 1.53-2.07). Surgical indications associated with increased oophorectomy with normal resultant pathology were family history of cancer (OR, 3.09; 95% CI, 1.94-4.94), endometrial hyperplasia (OR, 2.36; 95% CI, 1.38-4.01), endometriosis (OR, 2.01; 95% CI, 1.30-3.09), and cervical dysplasia (OR, 1.91; 95% CI, 1.12-3.28). Removal of histologically normal ovaries is performed in nearly 1 of every 4 women age <51 years undergoing hysterectomy for benign indications. Factors associated include age closer to menopause, surgical approach, and certain indications for hysterectomy. Reducing the rate of elective oophorectomy in low-risk, premenopausal women may be a target for quality improvement efforts. Future work should continue to evaluate this practice, associated factors, physician counseling, and patient decision-making.