Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Obstet Gynecol. 2013 Apr;121(4):717-726. doi: 10.1097/AOG.0b013e3182887a47.
Emerging data suggest that oophorectomy at the time of hysterectomy for benign indications may increase long-term morbidity and mortality. We performed a population-based analysis to estimate the rates of oophorectomy in women undergoing hysterectomy for benign indications.
The Perspective database was used to estimate the rate of ovarian preservation in women aged 40-64 years who underwent hysterectomy for benign indications. Hierarchical mixed-effects regression models were developed to estimate the influence of patient, procedural, physician, and hospital characteristics on ovarian conservation. Between-hospital variation in ovarian preservation also was estimated.
Among 752,045 women, 348,972 (46.4%) underwent bilateral oophorectomy, whereas 403,073 (53.6%) had ovarian conservation. Stratified by age, the rate of ovarian conservation was 74.3% for those younger than 40 years of age; 62.7% for those 40-44 years of age; 40.8% for those 45-49 years of age; 25.2% for those 50-54 years of age; 25.5% for those 55-59 years of age; and 31.0% for those 60-64 years of age. Younger age and more recent year of surgery had the strongest association with ovarian conservation. The observed patient, procedural, physician, and hospital characteristics accounted for only 46% of the total variation in the rate of ovarian conservation; 54% of the variability remained unexplained, suggesting a large amount of intrinsic between-hospital variation in the decision to perform oophorectomy.
The rate of ovarian conservation is increasing, particularly among women younger than 50 years old. Although demographic and clinical factors influence the decision to perform oophorectomy, there appears to be substantial between-hospital variation in performance of oophorectomy that remains unexplained by measurable patient, physician, or hospital characteristics.
II.
新出现的数据表明，因良性指征行子宫切除术时同时切除卵巢可能会增加长期发病率和死亡率。我们进行了一项基于人群的分析，以估计因良性指征行子宫切除术的女性中卵巢切除术的比率。
使用 Perspective 数据库来估计年龄在 40-64 岁之间因良性指征行子宫切除术且保留卵巢的女性的比率。建立分层混合效应回归模型来估计患者、手术、医生和医院特征对卵巢保留的影响。还估计了医院间卵巢保留的差异。
在 752045 名女性中，348972 名（46.4%）行双侧卵巢切除术，而 403073 名（53.6%）保留卵巢。按年龄分层，年龄小于 40 岁的女性保留卵巢的比率为 74.3%；40-44 岁的为 62.7%；45-49 岁的为 40.8%；50-54 岁的为 25.2%；55-59 岁的为 25.5%；60-64 岁的为 31.0%。年轻和最近的手术年份与卵巢保留的相关性最强。观察到的患者、手术、医生和医院特征仅解释了卵巢保留率总变异的 46%；54%的变异性仍无法解释，这表明在决定进行卵巢切除术方面存在大量医院间固有差异。
卵巢保留率在增加，尤其是在 50 岁以下的女性中。尽管人口统计学和临床因素影响行卵巢切除术的决定，但在实施卵巢切除术方面似乎存在大量无法用可测量的患者、医生或医院特征来解释的医院间差异。
II 级。
