title: 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.
authors.affiliation: From the 1Hormonal and Reproductive Epidemiology Branch, 2Biostatistics Branch, and 3Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD; and 4John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Gierach
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Pfeiffer
authors.forename: Deesha A
authors.initials: DA
authors.lastname: Patel
authors.forename: Amanda
authors.initials: A
authors.lastname: Black
authors.forename: Catherine
authors.initials: C
authors.lastname: Schairer
authors.forename: Abegail
authors.initials: A
authors.lastname: Gill
authors.forename: Louise A
authors.initials: LA
authors.lastname: Brinton
authors.forename: Mark E
authors.initials: ME
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000401:mortality*; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D010052:Ovariectomy / Q000401:mortality*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D058994:Salpingectomy / Q000401:mortality*; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D014481:United States / Q000453:epidemiology