Objectives: As of 2019, the National Comprehensive Cancer Network (NCCN) recommends discussing concurrent hysterectomy for BRCA1 patients undergoing bilateral salpingo-oophorectomy (BSO) given the increased risk of serous uterine cancers; hysterectomy may also confer the benefit of avoiding progesterone when hormone therapy is desired after oophorectomy. Given the lack of specific or defined guidelines, our objective was to analyze trends and associative factors of risk-reducing or therapeutic BSO with concurrent hysterectomy or endometrial sampling over ten years at a large institution. Methods: We searched all patients undergoing BSO at three sites affiliated with one institution from 2011 to 2021. Patients undergoing BSOs due to a known germline mutation (BRCA 1/2, Lynch Syndrome (LS), or RAD51C/D, BRIP1), family history of ovarian cancer, or personal history of hormone receptor-positive (HR) breast cancer were included in our study. Demographic information, concurrent hysterectomy or endometrial sampling (dilation and curettage or endometrial biopsy), and additional indications for uterine surgery listed as the preoperative diagnosis on the operative report were recorded. Chi-square analyses and multinomial regression analyses were performed. Regression coefficients were converted to relative risk ratios (RR) and 95% confidence intervals (CI). All statistics were performed with Stata software. Results: Of the 650 patients who underwent BSO, 368 had a germline mutation (313 BRCA1/2, 14 LS, and 41 other), 154 had a family history of ovarian cancer, and 370 had a personal history of HR breast cancer. The median age was 49 years (IQR: 43-57). Most (552, 85%) patients were White, 35 (5%) were Black, 34 (5%) were Asian, and 29 (4%) were other. One-hundred thirteen patients had additional preoperative indications, including adnexal cyst (68), fibroids (24), endometrial polyp or thickening (15), abnormal uterine bleeding (12) endometriosis or adenomyosis (4), prolapse (3), or cervical dysplasia (3). A significant decrease in concurrent hysterectomy and increase in endometrial sampling was noted from June 2011 to June 2015 compared to June 2016 to July 2021 (Figure 1, X2 =50.65, p<.0001). In BRCA1 patients after 2019, there was a significant change in concurrent surgery to lower numbers of hysterectomies but increased endometrial sampling (X2 =17.35, p<.001). Multinomial regression analysis demonstrated a significant association between the Black race (RR: 2.81, 95% CI: 1.27-6.22, p=.011) and personal history of breast cancer (RR: 1.81, 95% CI: 1.11-2.94, p=.017) with concurrent hysterectomy; no association with BRCA1/2 mutation was noted. All LS patients underwent concurrent hysterectomy or had an already surgically absent uterus. Hysterectomy and endometrial sampling were associated with additional preoperative indications (RR: 4.34, 95% CI: 2.57-7.32, p<.001; RR: 3.41, 95% CI: 1.79-6.50, p<.001). There was no significant association between concurrent hysterectomy or endometrial sampling based on family history or age. Conclusions: While the presence of BRCA1/2 mutation was not associated with concurrent uterine surgery, Black women and women with a history of breast cancer were more likely to have undergone concurrent hysterectomy. At the same time, the rate of concurrent hysterectomy declined over the 10-year period. Continued work on risks and benefits is needed to help standardize recommendations for concurrent gynecologic procedures in women undergoing BSO. Objectives: As of 2019, the National Comprehensive Cancer Network (NCCN) recommends discussing concurrent hysterectomy for BRCA1 patients undergoing bilateral salpingo-oophorectomy (BSO) given the increased risk of serous uterine cancers; hysterectomy may also confer the benefit of avoiding progesterone when hormone therapy is desired after oophorectomy. Given the lack of specific or defined guidelines, our objective was to analyze trends and associative factors of risk-reducing or therapeutic BSO with concurrent hysterectomy or endometrial sampling over ten years at a large institution. Methods: We searched all patients undergoing BSO at three sites affiliated with one institution from 2011 to 2021. Patients undergoing BSOs due to a known germline mutation (BRCA 1/2, Lynch Syndrome (LS), or RAD51C/D, BRIP1), family history of ovarian cancer, or personal history of hormone receptor-positive (HR) breast cancer were included in our study. Demographic information, concurrent hysterectomy or endometrial sampling (dilation and curettage or endometrial biopsy), and additional indications for uterine surgery listed as the preoperative diagnosis on the operative report were recorded. Chi-square analyses and multinomial regression analyses were performed. Regression coefficients were converted to relative risk ratios (RR) and 95% confidence intervals (CI). All statistics were performed with Stata software. Results: Of the 650 patients who underwent BSO, 368 had a germline mutation (313 BRCA1/2, 14 LS, and 41 other), 154 had a family history of ovarian cancer, and 370 had a personal history of HR breast cancer. The median age was 49 years (IQR: 43-57). Most (552, 85%) patients were White, 35 (5%) were Black, 34 (5%) were Asian, and 29 (4%) were other. One-hundred thirteen patients had additional preoperative indications, including adnexal cyst (68), fibroids (24), endometrial polyp or thickening (15), abnormal uterine bleeding (12) endometriosis or adenomyosis (4), prolapse (3), or cervical dysplasia (3). A significant decrease in concurrent hysterectomy and increase in endometrial sampling was noted from June 2011 to June 2015 compared to June 2016 to July 2021 (Figure 1, X2 =50.65, p<.0001). In BRCA1 patients after 2019, there was a significant change in concurrent surgery to lower numbers of hysterectomies but increased endometrial sampling (X2 =17.35, p<.001). Multinomial regression analysis demonstrated a significant association between the Black race (RR: 2.81, 95% CI: 1.27-6.22, p=.011) and personal history of breast cancer (RR: 1.81, 95% CI: 1.11-2.94, p=.017) with concurrent hysterectomy; no association with BRCA1/2 mutation was noted. All LS patients underwent concurrent hysterectomy or had an already surgically absent uterus. Hysterectomy and endometrial sampling were associated with additional preoperative indications (RR: 4.34, 95% CI: 2.57-7.32, p<.001; RR: 3.41, 95% CI: 1.79-6.50, p<.001). There was no significant association between concurrent hysterectomy or endometrial sampling based on family history or age. Conclusions: While the presence of BRCA1/2 mutation was not associated with concurrent uterine surgery, Black women and women with a history of breast cancer were more likely to have undergone concurrent hysterectomy. At the same time, the rate of concurrent hysterectomy declined over the 10-year period. Continued work on risks and benefits is needed to help standardize recommendations for concurrent gynecologic procedures in women undergoing BSO.