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Adnexal surgery at the time of hysterectomy in women 65 years and older undergoing hysterectomy for prolapse: do practice trends differ by route of surgery?

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Abstract

Introduction and hypothesis

The objective was to determine whether the rate of adnexal surgery varies by route of hysterectomy in women over the age of 65 undergoing hysterectomy for prolapse. We hypothesized that women undergoing vaginal hysterectomy would be less likely to undergo bilateral salpingo-oophorectomy (BSO) at the time of their hysterectomy for prolapse.

Methods

This was a cross-sectional analysis using the National Inpatient Sample (NIS) database. Our primary outcome was concomitant adnexal surgery performed at the time of hysterectomy, classified into five groups: BSO, unilateral salpingo-oophorectomy (USO), bilateral salpingectomy (BS), other adnexal surgery, and no adnexal surgery. The study sample included women aged 65 years and older who underwent hysterectomy between 1 January 2009 and 31 December 2014 and with a diagnosis of genital prolapse.

Results

Of the 91,292 patients over the age of 65 who underwent a hysterectomy for prolapse, the majority of hysterectomies were vaginal (69%), followed by abdominal (13%), laparoscopic (11%), and robotic (7%). The number of women having a hysterectomy and undergoing a BSO was much lower for vaginal than for other hysterectomy types; 20.3% of women undergoing vaginal hysterectomies had a BSO, compared with 79.2% in abdominal, 81.8% in laparoscopic, and 73.8% in robotic-assisted procedures. Women who received vaginal hysterectomies were five times as likely (RR: 5.02, 95% CI: 4.70–5.35) to have no concomitant adnexal procedure compared with other routes of hysterectomy.

Conclusions

Women over the age of 65 undergoing hysterectomy for prolapse are significantly less likely to have adnexal surgery if undergoing hysterectomy via vaginal route compared with the other routes.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, FL, 33606, Tampa, USA

    Kristie A. Greene, Allison M. Wyman, Nupur Tamhane & Renee M. Bassaly

  2. College of Public Health, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Jean Paul Tanner & Jason L. Salemi

Authors
  1. Kristie A. Greene
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  2. Allison M. Wyman
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  3. Nupur Tamhane
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  4. Jean Paul Tanner
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  5. Renee M. Bassaly
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  6. Jason L. Salemi
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Contributions

K.A. Greene: protocol development, data collection, data analysis, manuscript preparation; A.M. Wyman: protocol development, manuscript preparation; N. Tamhane: protocol development, data collection, manuscript preparation; J.P. Tanner: protocol development, data collection, data analysis, manuscript preparation; R.M. Bassaly: manuscript preparation; J.L. Salemi: protocol development, data collection, data analysis, manuscript preparation.

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Correspondence to Kristie A. Greene.

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Conflicts of interest

The authors have no conflicts of interest to declare regarding the publication of this paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the University of South Florida or Baylor College of Medicine. The publicly available database used in this study is de-identified; therefore, this study was deemed exempt by the Institutional Review Board of Baylor College of Medicine.

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Greene, K.A., Wyman, A.M., Tamhane, N. et al. Adnexal surgery at the time of hysterectomy in women 65 years and older undergoing hysterectomy for prolapse: do practice trends differ by route of surgery?. Int Urogynecol J 32, 2185–2193 (2021). https://doi.org/10.1007/s00192-020-04663-0

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  • DOI: https://doi.org/10.1007/s00192-020-04663-0

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