Substantial variability in ovarian conservation at hysterectomy for endometrial hyperplasia - 20/07/22
, Caroline J. Violette, MD a, Rachel S. Mandelbaum, MD a, c, Chelsey A. Harris, MD a, Amin Tavakoli, MD a, Maximilian Klar, MD, MPH d, Donna Shoupe, MD, MBA c, Lynda D. Roman, MD a, bAbstract |
Background |
Although ovarian conservation at hysterectomy for benign gynecologic disease has demonstrated mortality benefit in young patients and this benefit may be sustained up to age 65 years, there is a scarcity of data regarding ovarian conservation in those with a diagnosis of endometrial hyperplasia, a premalignant uterine condition.
Objective |
This study aimed to examine patient, hospital, treatment, and histology characteristics related to ovarian conservation at the time of inpatient hysterectomy for endometrial hyperplasia.
Study Design |
The Healthcare Cost and Utilization Project’s National Inpatient Sample was retrospectively queried to examine patients aged ≤65 years with endometrial hyperplasia who had inpatient hysterectomy from January 2016 to December 2019. The exclusion criteria included concurrent gynecologic malignancy, adnexal pathology, and lymphadenectomy. Cases were grouped by adnexal surgery status (ovarian conservation or oophorectomy). A multivariable binary logistic regression model was used to identify independent characteristics for ovarian conservation. A classification tree was constructed with recursive partitioning analysis to examine utilization patterns of ovarian conservation.
Results |
Overall, 3105 patients (31.1%) underwent ovarian conservation at hysterectomy among 9975 patients. The utilization of ovarian conservation decreased gradually until age 45 years and then markedly decreased by age 52 years (63.3%–15.3%; P<.001). In a multivariable analysis, younger age, non-White, urban nonteaching centers, and vaginal hysterectomy were associated with increased utilization of ovarian conservation, whereas endometrial hyperplasia with atypia, obesity, comorbidity, large bed capacity centers, and Midwest and South regions were associated with decreased utilization of ovarian conservation (all, P<.05). A classification tree identified 17 utilization patterns for ovarian conservation, ranging from 7.8% to 100.0% (absolute rate difference, 92.2%).
Conclusion |
The utilization of ovarian conservation at the time of inpatient hysterectomy in patients undergoing surgical management for endometrial hyperplasia started decreasing in their mid-40s and seemed to occur earlier than in benign hysterectomy. There was substantial variability in ovarian conservation at the time of hysterectomy for endometrial hyperplasia based on patient, hospital, surgical, and histology factors, suggesting the possible benefit of clinical practice guidelines for ovarian conservation in this population.
Le texte complet de cet article est disponible en PDF.Key words : characteristics, endometrial hyperplasia, hysterectomy, ovarian conservation, utilization
Plan
| K.M. and C.J.V. contributed equally to this work. |
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| This study is a retrospective cohort study. |
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| This study received funding from the Ensign Endowment for Gynecologic Cancer Research (K.M.). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| The authors report no conflict of interest. |
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| L.D.R. served as a consultant for Quantgene. |
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| This study was deemed exempt by the institutional review board of the University of Southern California (HS-16-00481). |
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| The data on which this study was based are publicly available on request at Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (nisoverview.jsp) |
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| K.M. affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. The National Inpatient Sample classified the race and ethnicity, and the current study used the default grouping for analysis. |
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| Cite this article as: Matsuo K, Violette CJ, Mandelbaum RS, et al. Substantial variability in ovarian conservation at hysterectomy for endometrial hyperplasia. Am J Obstet Gynecol 2022;227:255.e1-18. |
Vol 227 - N° 2
P. 255.e1-255.e18 - août 2022 Retour au numéro
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