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

• Published in: American journal of obstetrics and gynecology 2015-11, Vol.213 (5), p.716.e1-716.e6
• Main Authors: Karp, Natalie E., MD, Fenner, Dee E., MD, Burgunder-Zdravkovski, Lorraine, BSN, Morgan, Daniel M., MD
• Format: Article
• Language: English
• Subjects: Adult; Female; Humans; hysterectomy; Hysterectomy - statistics & numerical data; Incidental Findings; Logistic Models; Middle Aged; Obstetrics and Gynecology; oophorectomy; Ovarian Neoplasms - epidemiology; Ovariectomy - statistics & numerical data; premenopausal; Uterine Neoplasms - epidemiology; Uterine Neoplasms - surgery
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2015.05.062

Objective 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 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. Results 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). Conclusion Removal of histologically normal ovaries is performed in nearly 1 of every 4 women age