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Factors Affecting Prophylactic Oophorectomy in Postmenopausal Women

From the Robert Wood Johnson Clinical Scholars Program, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, and the Welch Center for Prevention, Epidemiology, and Clinical Research, and Department of Epidemiology, The Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland.

Address reprint requests to: Cary P. Gross, MD, Primary Care Center, Yale University School of Medicine, 333 Cedar Street, PO Box 208025, New Haven, CT 06520-8025, E-mail: cary.gross{at}yale.edu

Objective: Prophylactic oophorectomy performed concomitantly with hysterectomy may prevent ovarian cancer. Our goal was to better understand the basis for performing concomitant oophorectomy and to determine whether this procedure is associated with increased morbidity.

Methods: Our cross-sectional study used a hospital discharge database to identify women 50 years and older who, between 1994–1996, had hysterectomies in Maryland for a benign condition. We used multiple logistic regression to examine the independent effect of physician and patient factors on the likelihood of receiving a concomitant oophorectomy.

Results: Concomitant oophorectomy was performed in 61% of the 6227 women in our sample. Patients undergoing total abdominal hysterectomy (odds ratio [OR] 11.42; 95% confidence interval [CI] 9.65, 13.51) and laparoscopically assisted vaginal hysterectomy (OR 11.34; 95% CI 8.13, 15.81) were substantially more likely to have an oophorectomy than patients treated with vaginal hysterectomy, after adjusting for diagnosis and other covariates. We also found significant variation in the likelihood of receiving oophorectomy for women undergoing vaginal hysterectomy in different geographic regions. Additionally, physicians who performed many vaginal hysterectomies were significantly more likely to perform a concomitant oophorectomy. After adjusting for type of procedure, diagnosis, comorbidities, and age, oophorectomy was not associated with increased surgical morbidity.

Conclusion: These results suggest that there are marked variations in physician practice style for concomitant oophorectomy. The variation across geographic regions and with case volume suggests the influence of nonclinical factors on oophorectomy rates.