Salpingo-Oophorectomy Rates at Time of Benign Hysterectomy in Premenopausal Women: Demographic Variations Within a Large Integrated Health Care System Over 10 Years

INTRODUCTION: Bilateral salpingo-oophorectomy (BSO) performed during benign hysterectomy remains a controversial practice. While it offers benefits, such as reduced ovarian cancer risk, it poses significant risks, including increased cardiovascular disease and all-time mortality when performed before age 45. Despite guidelines discouraging prophylactic BSO, the procedure remains common, disproportionately affecting Hispanic and African American patients. Conflicting studies highlight these racial disparities in BSO rates and postoperative outcomes, underscoring the need for further investigation into the factors influencing these variations. OBJECTIVE: This study aims to assess the incidence and demographic variations of BSO performed during benign hysterectomy in premenopausal women within a large integrated healthcare system. METHODS: This retrospective observational study included women aged 18–50 who underwent a benign hysterectomy at an integrated healthcare facility between January 2010 and December 2019. The primary intervention of interest was concurrent BSO performed at the time of hysterectomy. Procedure codes from the medical record database were used to identify surgical techniques and to collect relevant demographic data for analysis. RESULTS: Among a total of 28,080 patients who underwent benign hysterectomy, 13.4% (n=3,754) had a concurrent BSO. From 2010 to 2019, preliminary results showed the overall rates of BSO steadily declined, with rates dropping from 21.6% in 2010 to 7.1% in 2019. BSO rates varied across racial and ethnic groups. White women consistently had the highest rates, beginning at 25.4% in 2010 and decreasing to 8.7% in 2019. In contrast, Black women had the lowest rates, starting at 17.9% in 2010 and dropping to 3.1% in 2019. Hispanic women showed a decline from 16.2% in 2010 to 5.7% in 2019, while Asian women also experienced a decrease, from 22.6% in 2010 to 8.2% in 2019. When examining BSO rates across socioeconomic status using NDI quintiles, NDI quintile 3 consistently showed the highest rates, beginning at 23.0% in 2010 and decreasing to 6.3% in 2019. Over the same period, quintiles 1, 2, 4, and 5 also experienced steady declines, but the patterns suggest that patients in the middle quintile (quintile 3) were more likely to undergo BSO compared to other socioeconomic groups. CONCLUSIONS: The study demonstrates a steady decline in the incidence of BSO among premenopausal women undergoing benign hysterectomy within the large integrated healthcare system network from 2010 to 2019. Despite this decline, notable demographic variations persist, with White patients and those in NDI quintile 3 consistently exhibiting higher BSO rates compared to other racial and socioeconomic groups. These findings underscore the importance of addressing the underlying factors driving these demographic disparities (Figure 1).