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. © 2022 International Federation of Gynecology and Obstetrics