Utilizations and characteristics of ovarian conservation at hysterectomy for cervical carcinoma in-situ.

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 National Inpatient Sample, 1/2016-12/2019. The study population included 6,605 patients aged ≤65 with cervical carcinoma in-situ who underwent hysterectomy. Exposure alocation was the adnexal procedure status (ovarian conservation versus 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 remain stable until age 40, ranging from 88.0% to 78.6% (P-trend=0.236), after which time the rate sharply decreases 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 hospital 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.