Objective: To examine the trends and characteristics of ovarian conservation at time of hysterectomy in cervical carcinoma in situ.
Methods: This is a retrospective cohort study examining the Healthcare Cost and Utilization Project's National Inpatient Sample, January 2016 to December 2019. The study population included 6605 patients aged less than 65 years with cervical carcinoma in situ who underwent hysterectomy. Exposure allocation was the adnexal procedure status (ovarian conservation vs. oophorectomy). Main outcome measures were temporal trends of ovarian conservation over time and per patient age. A classification-tree was constructed to examine utilization patterns of ovarian conservation.
Results: Ovarian conservation was performed in 57.2% of patients. Ovarian conservation rates were unchanged over time (P-trend = 0.219). Ovarian conservation rates remained stable until age 40 years, ranging from 88.0% to 78.6% (P-trend = 0.236), after which time the rate sharply decreased from 78.6% to 19.1% (P-trend <0.001). In a multivariable analysis, younger age, fewer comorbidities, higher household income, vaginal hysterectomy, and surgery at small bed capacity non-rural hospitals were associated with ovarian conservation (all, P < 0.05). There were 17 utilization patterns of ovarian conservation for which the rate ranged from 17.2% to 94.4% (absolute rate difference 77.2%, P < 0.001).
Conclusion: Decrease in the utilization of ovarian conservation at hysterectomy for cervical carcinoma in situ occurred at age 40 years, which is earlier than expected.
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