Long-term overall and disease-specific mortality associated with benign gynecologic surgery performed at different ages

Abstract

Objective: As bilateral salpingo-oophorectomy is frequently performed with hysterectomy for nonmalignant conditions, defining health outcomes associated with benign bilateral salpingo-oophorectomy performed at different ages is critical.

Methods: We assessed mortality risk associated with benign total abdominal hysterectomy or bilateral salpingo-oophorectomy among 52,846 Breast Cancer Detection Demonstration Project follow-up study participants. Surgery and risk factor data were ascertained via baseline interview (1979-1986) and three questionnaires (1987-1998). During follow-up through December 2005 (mean, 22.1 y), 13,734 deaths were identified. We estimated hazard ratios (HRs) and 95% CIs for overall and disease-specific mortality for total abdominal hysterectomy or bilateral salpingo-oophorectomy performed by age 35, 40, 45, 50, or 55 years, compared with not having surgery, using landmark analyses and multivariable Cox regression.

Results: Undergoing bilateral salpingo-oophorectomy by age 35 years was associated with increased mortality risk (HR35 y, 1.20; 95% CI, 1.08-1.34), which decreased with age (HR40 y, 1.12; 95% CI, 1.04-1.21; HR45 y, 1.10; 95% CI, 1.03-1.17). Total abdominal hysterectomy alone performed by age 40 years was associated with increased mortality risk to a lesser extent (HR40 y, 1.08; 95% CI, 1.01-1.15). Analyses based on matched propensity scores related to having gynecologic surgery yielded similar results. Elevated mortality risks were largely attributable to noncancer causes.

Conclusions: Benign gynecologic surgeries among young women are associated with increased mortality risk, which attenuates with age.

Figure 1

Survival Model Results for Landmark Analyses Relating Between Benign Gynecologic Surgery Status to All-cause Mortality, According to the Age by Which Surgeries Were Performed, BCDDP Follow-up Study, Follow-up From 1979-1986 to 2005 (n=52,846) ^a Landmark analyses, using Cox proportional hazards models, adjusted for body mass index, alcohol use, smoking, menopausal hormone therapy use, and birth cohort. BCDDP, Breast Cancer Detection and Demonstration Project; BSO, bilateral salpingo-oophorectomy; CI, confidence interval; TAH, transabdominal hysterectomy; HR, hazard ratio.