LAS VEGAS – Performance of oophorectomy at the time of benign hysterectomy did not decline immediately following publication of data from the Nurses’ Health Study showing that removal of the ovaries during hysterectomy was associated with negative outcomes.
The finding, from a retrospective chart review of 574 women who underwent benign hysterectomy at Brigham and Women’s Hospital in Boston, suggests that medical decision making regarding oophorectomy "is complex. Nonetheless, given the significant consequences that can result from removal of the ovaries, we definitely need to do more studies about physician attitudes and practices regarding ovarian conservation," said Dr. Tiffany Jackson of the hospital’s division of minimally invasive gynecology.
In May 2009, the prospective, observational study of 29,380 women from the Nurses’ Health Study who had hysterectomy for benign disease showed that over 24 years of follow-up, the hazard ratio for total mortality was a statistically significant 1.12 for the 16,345 who had bilateral oophorectomy, compared with the 13,035 with ovarian conservation. For fatal and nonfatal coronary heart disease, the hazard ratio was 1.17; for lung cancer, it was 1.26. Although oophorectomy was associated with a decreased risk of breast and ovarian cancer, it was not associated with increased survival in any analysis (Obstet. Gynecol. 2009;113:1027-37).
In the current study, 244 women who had hysterectomies before May 2009 were compared with 330 who had the procedure after that time. Both groups had a mean age of 48 years. Body mass index was 29 kg/m2 for the pre–May 2009 patients and 28 for the post–May 2009 group.
Indications for surgery did not differ significantly between the two time periods except for menorrhagia, which accounted for 56% of the pre–May 2009 group and 45% of those having post–May 2009 operations. Fibroids were the most common indication in both time periods, accounting for 75% before May 2009 and 68% after May 2009, Dr. Jackson reported.
Laparoscopy was the most common hysterectomy route in both time periods, but it did increase significantly (from 45% of the pre–May 2009 patients to 58% after). Abdominal hysterectomies made up 26% of the pre–May 2009 procedures and 23% of those after that.
Bilateral oophorectomy at the time of hysterectomy was performed in 23% of both the pre- and post–May 2009 groups. Although oophorectomy did increase with age, the differences between the two time periods were still insignificant. Oophorectomy was performed in 12% of women younger than 45 years during both time periods; in 23% and 22% of women aged 45-54 years in pre–May 2009 and post–May 2009, respectively; and in 42% of women older than 55 years before May 2009, compared with 37% of those having operations after that date.
Dr. Jackson pointed out that the rate of ovarian conservation at her institution is higher than the national average, a limitation to the generalizability of the study findings. In addition, there has been only a short time interval since the Nurses’ Health Study data were published, and physician practices could change with time.
Dr. Jackson stated that she had no disclosures. The study’s principal investigator, Dr. Jon Einarsson, is a consultant for Ethicon Endo-Surgery.