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 and 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 years), 13,734 deaths were identified. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and disease-specific mortality following total abdominal hysterectomy or bilateral salpingo-oophorectomy performed by ages 35, 40, 45, 50, or 55 years compared to not having surgery using landmark analyses and multivariable Cox regression.
Results
Undergoing bilateral salpingo-oophorectomy by age 35 was associated with increased mortality risk (HR35 years=1.20, 95% CI: 1.08, 1.34), which decreased with age (HR40 years=1.12, 95% CI: 1.04, 1.21; HR45 years=1.10, 95% CI: 1.03, 1.17). Total abdominal hysterectomy alone performed by age 40 was associated with increased mortality risk to a lesser extent (HR40 years=1.08, 95% CI: 1.01, 1.15). Analyses based on matched propensity scores related to having gynecological surgery yielded similar results. Elevated mortality risks were largely attributable to non-cancer causes.
Conclusions
Benign gynecologic surgeries among young women are associated with increased mortality risk, which attenuates with age.