Predictors of bilateral salpingo-oophorectomy at the time of hysterectomy and the potential for ovarian preservation
CANSAGE ePoster Library. Sunderji Z. 09/27/19; 279825; eP-143
Dr. Zahra Sunderji
Dr. Zahra Sunderji
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Abstract
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Objectives: 1) To retrospectively review indications for bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy. 2) To determine the proportion of cases with the potential for ovarian preservation. Methods: A retrospective review of hysterectomies performed by gynaecologists at six Ontario hospitals from July 2016 to June 2018. Cases including BSOs were classified as ‘indicated’ or ‘avoidable’. ‘Avoidable’ criteria: ≤ 51 years old, benign preoperative diagnosis other than endometriosis and absence of intraoperative endometriosis and adhesions. Remainder of cases were classified as ‘indicated’. Chi-square test was used to compare proportions, and odds ratios were calculated. Results: Of the 2656 hysterectomies reviewed, 749 patients had a concurrent BSO. Of these, 68% were ‘indicated’ and 32% were ‘avoidable’ based on preoperative diagnosis. There was significant inter-hospital variation in the proportion of ‘indicated’ BSOs ranging from 45.3% to 76.9%, chi square test p < 0.001. ‘Indicated’ BSOs were more commonly performed at academic centers compared to community hospitals (70% vs 63%, OR 1.42, 95% CI 1.02-1.97, p=0.04). A larger proportion of fellowship-trained surgeons performed ‘indicated’ BSOs based on preoperative diagnosis compared to generalist surgeons (75% vs 63%, OR 1.76, 95% CI 1.26-2.44, p=0.001). 43.9% of ‘avoidable” BSOs were ≤ 51 years of age. Of this group, 58% had no intraoperative endometriosis and no adhesions. Conclusions: A large proportion of BSOs performed at the time of hysterectomy lacked a preoperative indication. Quality improvement initiatives should focus on standardizing practice with respect to BSO among gynaecologic surgeons, potentially avoiding surgical menopause for some women.
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