Trends in bilateral salpingo-oophorectomy among Taiwanese women undergoing benign hysterectomy: a population-based, pooled, cross-sectional study.
OBJECTIVE
This study aims to examine recent trends in the performance of elective bilateral salpingo-oophorectomy at benign hysterectomy and to identify associated patient and provider-related characteristics from 2000 to 2010.


METHODS
We conducted a population-based, pooled, cross-sectional study using claims data from Taiwan's National Health Insurance program. Women aged 20 years or older who underwent concurrent oophorectomy at benign hysterectomy (n = 26,419) were compared with women who did not undergo concurrent oophorectomy at benign hysterectomy (n = 153,793). A generalized estimating equation model was applied to logistic regressions, and separate models were estimated to account for age interactions.


RESULTS
The overall oophorectomy rate declined steadily from 22.1% in 2000 to 9.9% in 2010, particularly in women aged 45 to 49 years (decreased by 80%). Women aged 55 years or older who had a comorbid illness or a catastrophic illness, underwent abdominal or laparoscopic surgical operation, and were admitted to regional hospitals or medical centers were more likely to undergo oophorectomy at hysterectomy, whereas women with a preoperative diagnosis of uterine prolapse, with a well-defined monthly wage, and undergoing vaginal hysterectomy were less likely to undergo oophorectomy.


CONCLUSIONS
Age, socioeconomic status, presence of comorbid illness, hysterectomy approach, hospital accreditation level, and disease diagnosis influence oophorectomy rate in Taiwan, a country with national health insurance. Studies on the possible long-term health risks of elective oophorectomy and the emergence of increasing evidence on ovarian cancers of serous histology (such as tubal carcinoma) since the early 2000s may have influenced patients' and physicians' decision-making in favor of ovarian conservation, leading to the observed downward trend among Taiwanese women from 2000 to 2010.
From the 1Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 2Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Education and Research, Taipei City Hospital, Taipei, Taiwan; 4Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; and 5Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan.
Jerry Cheng-Yen
JC
Lai
Nicole
N
Huang
Kung-Liahng
KL
Wang
Hsiao-Yun
HY
Hu
I-Ting
IT
Chen
Yiing-Jenq
YJ
Chou
D000068:Accreditation; D000328:Adult; D000367:Age Factors; D000368:Aged; D002755:Choice Behavior; D015897:Comorbidity; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D008875:Middle Aged; D010052:Ovariectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D058994:Salpingectomy / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D012923:Social Class; D013624:Taiwan; D055815:Young Adult