期刊
MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY
卷 29, 期 5, 页码 523-530出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/GME.0000000000001951
关键词
Bilateral salpingo-oophorectomy; Hysterectomy; Menopause; Quality improvement
资金
- Department of Obstetrics and Gynecology at the University of Toronto, Mount Sinai Hospital Academic Medical Organization Innovation Fund
- Kavelman Fonn Foundation Grant through Sinai Health Foundation
This study retrospectively reviewed hysterectomies conducted in Ontario, Canada from 2016 to 2019 to evaluate the proportion of justified BSO and determine the prevalence of avoidable BSO. The findings showed that most BSOs were justified based on pathologic diagnosis, with endometrial cancer being the most common indication. However, 5.6% of BSOs were considered avoidable, highlighting the need for standardized practice in BSO.
Objectives: Evaluate the proportion of justified bilateral salpingo-oophorectomy (BSO) at hysterectomy, based on pathologic diagnosis, and determine prevalence of avoidable BSO based on pre- and intraoperative considerations and pathologic diagnosis. Methods: Retrospective review of hysterectomies at seven Ontario, Canada hospitals from 2016 to 2019. Surgeries completed by oncologists or for invasive placentation were excluded. Patient, case, and surgeon characteristics were recorded along with pathologic diagnoses. Avoidable BSO criteria were: preoperative diagnosis of cervical dysplasia or benign diagnosis other than endometriosis, gender dysphoria, risk reduction or premenstrual dysphoric disorder; age < 51 years; absence of intraoperative endometriosis and adhesions; unjustified pathology (where justified pathology was endometriosis or (pre)malignant diagnosis except for cervical dysplasia). Patients with avoidable BSO were compared to those having at least one criterion for BSO. Binary logistic regression identified factors most strongly associated with avoidable BSO. Results: Four thousand one hundred ninety-one hysterectomies were completed with 1,422 (33.9%) patients having concomitant BSO. Pathologic diagnosis justified BSO in most patients (1,035/1,422, 72.8%) with endometrial cancer being most common (439/1,422, 30.9%). When preoperative characteristics, intraoperative findings, and pathologic diagnoses were considered, 79 of 1,422 (5.6%) BSOs were avoidable. Compared to cases with at least one criterion for BSO, avoidable BSOs were more frequently completed by generalists (OR 1.80, 95% CI 1.10-2.99, P = 0.021), for preoperative diagnoses of abnormal uterine bleeding/menorrhagia (OR 3.82, 95% CI 2.35-6.30, P = 0.001) and fibroids (OR 4.25, 95% CI 2.63-6.92, P < 0.001). Conclusion: Pathologic diagnosis justified most BSOs at hysterectomy. BSO was avoidable in 5.6% of patients, underscoring the need to standardize practice of BSO.
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