背景:多达40%的55岁及以下患者在进行良性子宫切除术时同时进行双侧附件-卵巢切除术(BSO),BSO的实践变化与患者健康和社会因素有关。残疾在绝经前妇女中很常见,是更广泛的生殖健康的重要决定因素;然而,缺乏关于残疾妇女BSO率的研究。
目的:研究55岁以下成年女性在良性子宫切除术时使用BSO是否因先前存在的残疾状况而有所不同。
方法:这项基于人群的横断面研究使用了2016-2019年美国国家住院患者样本的数据。因良性妇科适应症而接受住院子宫切除术的女性(N=74,315)被归类为具有身体检查(6.1%),感官(0.1%),智力/发展(0.2%),或多重残疾(0.2%),与无残疾者相比。Logistic回归用于估计BSO率按残疾状态差异的风险比(RR),根据患者和临床因素进行调整。根据卵巢摘除的临床适应症的存在和年龄组,通过潜在可避免或潜在适当的BSO对模型进行分层。
结果:良性子宫切除术时的BSO发生率为26.0%,女性无残疾,体格障碍(33.2%;调整后RR1.10,95%CI1.05-1.14)或智力/发育障碍(31.1%;调整后RR1.32,95%CI1.02-1.64)者的发病率明显升高,多重残疾患者可能升高(38.2%;调整后RR1.20,95%CI0.94-1.45),感觉障碍患者的情况相似(31.2%;调整后RR0.98,95%CI0.83-1.13)。结果相似,但对潜在可避免和潜在适当的BSO具有较低的统计精度,发生在9.1%和17.0%的无残疾女性中,分别。在围绝经期45-49岁年龄组中,有任何残疾的女性的BSO发生率差异最大。
结论:残疾女性在良性子宫切除术时伴随BSO的发生率升高,特别是那些智力/发育障碍和围绝经期年龄的人,虽然有些估计是不精确的。以公平为重点的医师培训,包括手术咨询以及对残疾女性的流行病学和妇科疾病经验的研究可能是有益的。
Up to 40% of patients aged ≤55 years undergo concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy, with practice variation in bilateral salpingo-oophorectomy occurring along the lines of patient health and social factors. Disability is common in premenopausal women and is an important determinant of reproductive health more broadly; however, studies on bilateral salpingo-oophorectomy rates among women with disabilities are lacking.
This study aimed to examine whether the use of concomitant bilateral salpingo-oophorectomy at the time of benign hysterectomy differs by preexisting disability status in adult females aged ≤55 years.
This population-based cross-sectional study used data from the 2016-2019 US National Inpatient Sample. Females undergoing inpatient hysterectomy for a benign gynecologic indication (n=74,315) were classified as having physical (6.1%), sensory (0.1%), intellectual or developmental (0.2%), or multiple (0.2%) disabilities and compared with those without a disability. Logistic regression was used to estimate risk ratios for differences in bilateral salpingo-oophorectomy rates by disability status, adjusted for patient and clinical factors. Models were stratified by potentially avoidable or potentially appropriate bilateral salpingo-oophorectomy based on the presence of clinical indications for ovarian removal and by age group.
Bilateral salpingo-oophorectomy at the time of benign hysterectomy occurred in 26.0% of females without a disability, with rates clearly elevated in those with a physical (33.2%; adjusted risk ratio, 1.10; 95% confidence interval, 1.05-1.14) or intellectual or developmental (31.1%; adjusted risk ratio, 1.32; 95% confidence interval, 1.02-1.64) disability, possibly elevated in those with multiple disabilities (38.2%; adjusted risk ratio, 1.20; 95% confidence interval, 0.94-1.45), and similar in those with a sensory disability (31.2%; adjusted risk ratio, 0.98; 95% confidence interval, 0.83-1.13). The results were similar but with lower statistical precision for potentially avoidable and potentially appropriate bilateral salpingo-oophorectomy, which occurred in 9.1% and 17.0% of females without a disability, respectively. The largest differences in bilateral salpingo-oophorectomy rates among women with any disability were observed in the
perimenopausal 45- to 49-year age group.
Females with disabilities experienced elevated concomitant bilateral salpingo-oophorectomy rates at the time of benign hysterectomy, particularly those with an intellectual or developmental disability and those of
perimenopausal age, although some estimates were imprecise. Equity-focused physician training in surgical counseling and research into the epidemiology and experiences of gynecologic conditions among females with a disability may be beneficial.