Concomitant bilateral salpingo-oophorectomy during benign hysterectomy: clinical determinants, pathologic correlations, and the need for evidence-based guidelines

OBJECTIVE: The decision to perform concomitant oophorectomy at the time of benign hysterectomy may be influenced by factors such as individual characteristics, socioeconomic factors, and surgeon expertise. Although hysterectomy rates have declined, evidence-based guidance on when to perform concomitant oophorectomy remains limited. This study aimed to evaluate local practice patterns and identify factors associated with the decision to perform oophorectomy in women undergoing hysterectomy for benign indications. METHODS: Women aged 40-55 years who underwent hysterectomy for benign indications with or without concomitant oophorectomy at Başakşehir Çam and Sakura City Hospital between June 2020 and July 2021 were included in this retrospective cohort. Demographic, preoperative, intraoperative, postoperative, and pathologic data were analyzed to evaluate factors associated with concomitant bilateral oophorectomy during hysterectomy. RESULTS: Among 372 hysterectomy cases, 158 (42.5%) underwent concomitant bilateral salpingo-oophorectomy (BSO). Women in the BSO group were significantly older (49.38 ± 3.31 vs 45.37 ± 3.42 y; P < 0.001) and had a higher body mass index (BMI; 30.61 ± 5.09 vs 28.59 ± 4.91; P < 0.001). Ovarian cysts or masses were more frequently observed in the BSO group (84.2% vs 49.2%; P < 0.001). However, the proportion of pathologic findings beyond simple cysts was higher in the BSO group than in the non-BSO group (22% vs 6%; P < 0.001). Multivariable logistic regression showed that age, BMI, the presence of ovarian cysts, and endometrioma were independent predictors of BSO (overall model accuracy 85.9%; Nagelkerke R² = 0.65). No significant differences were observed in operative time, history of prior abdominal surgery, or comorbidities. CONCLUSIONS: Concomitant BSO remains commonly performed in perimenopausal women undergoing hysterectomy, and is primarily influenced by women's age, BMI, and intraoperative findings. Given the potential risks associated with surgical menopause, a more selective approach incorporating intraoperative assessment, guideline-based age thresholds, and improved counseling may help optimize clinical decision-making and surgical outcomes.