Practice Variation in Bilateral Salpingo-Oophorectomy at Benign Abdominal Hysterectomy

Practice variation in bilateral salpingo-oophorectomy at benign abdominal hysterectomy

A population-based study

[Posted 17/Jun/2021]

AUDIENCE: Ob/Gyn, Family Medicine

KEY FINDINGS: Marked between-surgeon variation in bilateral salpingo-oophorectomy rates, even after adjusting for patient case mix, suggests ongoing uncertainty in practice. Stronger evidence-based guidelines on the risks and benefits of salpingo-oophorectomy as women age are needed, particularly focusing on perimenopausal women.

BACKGROUND: Bilateral salpingo-oophorectomy at benign hysterectomy is not recommended in premenopausal women who are in the premenopausal stage because of its potential associations with increased all-cause mortality and cardiovascular disease; however, contemporary practice patterns are unknown. This study aimed to quantify between-surgeon variation in bilateral salpingo-oophorectomy and identify surgeon and patient characteristics associated with bilateral salpingo-oophorectomy to evaluate current quality of care and identify targets for knowledge translation and future research.

DETAILS: A population-based retrospective cross-sectional study of adult women (>=20 years) undergoing benign abdominal hysterectomy from 2014 to 2018 in Ontario, Canada was conducted. Hierarchical multivariable logistic regression models, stratified by age group (45, 45-54, >=55 years), were used to model between-surgeon variation after multivariable adjustment for patient and surgeon characteristics. Cases of bilateral salpingo-oophorectomy were classified as potentially appropriate or potentially avoidable based on the presence or absence of diagnostic indications. Of 44,549 eligible women, 17,797 (39.9%) underwent concurrent bilateral salpingo-oophorectomy, and 26,752 (60.1%) did not. In all three age strata, the individual surgeon providing care was one of the strongest factors influencing whether patients received bilateral salpingo-oophorectomy (median odds ratio, 2.00-2.53). Surgeons accounted for more than 22% of the residual observed variation in bilateral salpingo-oophorectomy in women aged 45-54 years compared with 16% and 14% of the residual observed variation in bilateral salpingo-oophorectomy in women aged 45 and >=55 years, respectively. Non-gynecologic patient factors, such as obesity (odds ratio, 1.33; 95% confidence interval, 1.17-1.52; P.001) and residing in low-income regions (odds ratio, 1.34; 95% confidence interval, 1.16-1.55; P.001), were also associated with bilateral salpingo-oophorectomy. Approximately 40% of patients who underwent bilateral salpingo-oophorectomy had no indication for the procedure in their discharge records.

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Source: Cusimano, M. C., Moineddin, R., Chiu, M. (2021). Practice variation in bilateral salpingo-oophorectomy at benign abdominal hysterectomy: a population-based study. Am J Obstet Gynecol. 2021; 224(6): 585.e1-30. Published: June, 2021. DOI: 10.1016/j.ajog.2020.12.1206.