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Avoidable bilateral salpingo-oophorectomy at hysterectomy: a large retrospective study
Ana-Maria Iancu1, Ally Murji1,2, Ovina Chow3
1Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
Menopause (New York, N.Y.)
|March 24, 2022
Summary
Bilateral salpingo-oophorectomy (BSO) at hysterectomy was justified by pathology in most cases. However, 5.6% of BSOs were avoidable, highlighting the need for standardized surgical practices.
Area of Science:
- Gynecologic Surgery
- Surgical Oncology
- Pathology
Background:
- Bilateral salpingo-oophorectomy (BSO) is often performed concurrently with hysterectomy.
- The justification for BSO based on pathologic findings requires careful evaluation.
Purpose of the Study:
- To assess the proportion of justified bilateral salpingo-oophorectomy (BSO) during hysterectomy based on pathologic diagnosis.
- To determine the prevalence of avoidable BSOs considering pre- and intraoperative factors and final pathology.
Main Methods:
- Retrospective review of 4,191 hysterectomies across seven Ontario hospitals (2016-2019).
- Exclusion of surgeries by oncologists or for invasive placentation.
- Analysis of patient, case, and surgeon characteristics, alongside pathologic diagnoses, to define avoidable BSO criteria.
Main Results:
- Concomitant BSO was performed in 33.9% (1,422/4,191) of hysterectomies.
- Pathologic diagnosis justified BSO in 72.8% (1,035/1,422) of cases, with endometrial cancer being the most common indication.
- Avoidable BSOs accounted for 5.6% (79/1,422) of cases, more frequent with generalists and for diagnoses like abnormal uterine bleeding or fibroids.
Conclusions:
- Pathologic findings justify the majority of bilateral salpingo-oophorectomies performed during hysterectomy.
- A small but significant proportion (5.6%) of BSOs were deemed avoidable, indicating a need for practice standardization.
