Appropriateness of hysterectomies at the time of surgical removal of presumed benign adnexal masses
Abstract
Objective
To evaluate factors that affect a gynecologist’s decision to remove an asymptomatic uterus at the time of removal of a presumed benign adnexal mass.
Methods
Retrospective chart review of hysterectomies conducted when removing presumed benign adnexal masses at a tertiary‐care academic center. Primary outcome was the final pathology of the adnexal mass to determine whether the hysterectomy was medically indicated. Secondary outcomes included the rate of postoperative complications.
Results
We included 185 out of 1415 charts. Most hysterectomies were performed by gynecologic oncologists (68.8%); 113 (61%) had a frozen section and of those, 76 (67.3%) were benign. Final adnexal pathology was benign in 135 (73%) cases. Using a bivariate analysis, menopausal status (P = 0.019), parity (P = 0.047), sonographic appearance of the mass (P = 0.049), and the physician’s preoperative suspicion for malignancy (P < 0.001) were significantly associated with the final adnexal pathology. At the multivariate level, only the physician’s suspicion for malignancy was significantly associated with the final adnexal pathology (P < 0.0001) with an odds ratio of 7.28 (95% confidence interval 3.11–17.02).
Conclusion
Despite gynecologists' capacity to predict the malignant nature of an adnexal mass, 135 of 185 (73%) hysterectomies were performed without a clear medical indication, at the time of removal of benign adnexal masses.