TY - JOUR

T1 - Long-Term Health Consequences After Ovarian Removal at Benign Hysterectomy

T2 - A Nationwide Cohort Study

AU - Gottschau, Mathilde

AU - Rosthøj, Susanne

AU - Settnes, Annette

AU - Aalborg, Gitte Lerche

AU - Viuff, Jakob Hansen

AU - Munk, Christian

AU - Jensen, Allan

AU - Kjær, Susanne K.

AU - Mellemkjær, Lene

PY - 2023

Y1 - 2023

N2 - BACKGROUND: More evidence is needed to substantiate current recommendations about removing ovaries during hysterectomy for benign conditions.OBJECTIVE: To compare long-term outcomes in women with and without bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign conditions.DESIGN: Emulated target trial using data from a population-based cohort.SETTING: Women in Denmark aged 20 years or older during 1977 to 2017.PARTICIPANTS: 142 985 women with hysterectomy for a benign condition, 22 974 with BSO and 120 011 without.INTERVENTION: Benign hysterectomy with or without BSO.MEASUREMENTS: The primary outcomes were overall hospitalization for cardiovascular disease (CVD), overall cancer incidence, and all-cause mortality through December 2018.RESULTS: Compared with women without BSO, women with BSO who were younger than 45 years at surgery had a higher 10-year cumulative risk for hospitalization for CVD (risk difference [RD], 1.19 percentage points [95% CI, 0.09 to 2.43 percentage points]). Women with BSO had a higher 10-year cumulative risk for cancer for ages 45 to 54 years (RD, 0.73 percentage point [CI, 0.05 to 1.38 percentage points]), 55 to 64 years (RD, 1.92 percentage points [CI, 0.69 to 3.25 percentage points]), and 65 years or older (RD, 2.54 percentage points [CI, 0.91 to 4.25 percentage points]). Women with BSO had higher 10-year mortality in all age groups, although the differences were statistically significant only for ages 45 to 54 years (RD, 0.79 percentage point [CI, 0.27 to 1.30 percentage points]). The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older.LIMITATION: Age was a proxy for menopausal status.CONCLUSION: The authors find that these results support current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer and suggest a cautious approach in postmenopausal women.PRIMARY FUNDING SOURCE: The Danish Cancer Society's Scientific Committee and the Mermaid Project.

AB - BACKGROUND: More evidence is needed to substantiate current recommendations about removing ovaries during hysterectomy for benign conditions.OBJECTIVE: To compare long-term outcomes in women with and without bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign conditions.DESIGN: Emulated target trial using data from a population-based cohort.SETTING: Women in Denmark aged 20 years or older during 1977 to 2017.PARTICIPANTS: 142 985 women with hysterectomy for a benign condition, 22 974 with BSO and 120 011 without.INTERVENTION: Benign hysterectomy with or without BSO.MEASUREMENTS: The primary outcomes were overall hospitalization for cardiovascular disease (CVD), overall cancer incidence, and all-cause mortality through December 2018.RESULTS: Compared with women without BSO, women with BSO who were younger than 45 years at surgery had a higher 10-year cumulative risk for hospitalization for CVD (risk difference [RD], 1.19 percentage points [95% CI, 0.09 to 2.43 percentage points]). Women with BSO had a higher 10-year cumulative risk for cancer for ages 45 to 54 years (RD, 0.73 percentage point [CI, 0.05 to 1.38 percentage points]), 55 to 64 years (RD, 1.92 percentage points [CI, 0.69 to 3.25 percentage points]), and 65 years or older (RD, 2.54 percentage points [CI, 0.91 to 4.25 percentage points]). Women with BSO had higher 10-year mortality in all age groups, although the differences were statistically significant only for ages 45 to 54 years (RD, 0.79 percentage point [CI, 0.27 to 1.30 percentage points]). The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older.LIMITATION: Age was a proxy for menopausal status.CONCLUSION: The authors find that these results support current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer and suggest a cautious approach in postmenopausal women.PRIMARY FUNDING SOURCE: The Danish Cancer Society's Scientific Committee and the Mermaid Project.

KW - Female

KW - Humans

KW - Cardiovascular Diseases/epidemiology

KW - Cohort Studies

KW - Hysterectomy/adverse effects

KW - Ovarian Neoplasms/surgery

KW - Ovariectomy/adverse effects

U2 - 10.7326/M22-1628

DO - 10.7326/M22-1628

M3 - Journal article

C2 - 37068275

VL - 176

SP - 596

EP - 604

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 5

ER -