This cohort study evaluates the reduction in risk of high-grade serous carcinoma among women undergoing opportunistic bilateral salpingectomy in Canada.

OBJECTIVE:To examine the association between post-diagnosis use of estrogen hormone therapy (EHT) and survival among patients diagnosed with invasive epithelial ovarian cancer by histotype before the age of 60. METHODS:In this retrospective, population-based, cohort study, we included all patients diagnosed with invasive epithelial ovarian cancer (EOC) between January 1, 1997, and December 31, 2020, who were under age 60 at diagnosis and survived at least one year after diagnosis. EHT use was restricted to systemic use, defined using provincial pharmacy dispensation records. We compared the survival of post-diagnosis EHT users to hormone therapy (HT) non-users using Cox proportional hazards regression with EHT use as a time-varying exposure and using a landmark analysis. RESULTS:Of the 2334 people included, 19.1% (n = 446) used EHT after their cancer diagnosis. EHT use was significantly associated with improved survival among people with serous ([adjusted hazard ratio [aHR], 0.71, 95% [CI] 0.58-0.87) and clear cell EOC (aHR, 0.52, 95% [CI] 0.28-0.97). As most of serous EOC is high-grade, this improved survival applies to high-grade serous cancer (HGSC). In contrast, EHT users showed worse survival among patients with the endometrioid histotype (aHR, 2.01, 95% [CI] 1.16-3.51). CONCLUSION:Post-diagnosis use of EHT is safe for patients diagnosed under age 60 with HGSC and likely for clear cell EOC. Thus, EHT can be used to manage menopausal sequelae in these patients. Our data suggest caution is warranted in patients with endometrioid EOC. More research is needed to understand the relationship between EHT and mucinous EOC survival.

Objective Assess the short-term surgical outcomes of bilateral salpingectomy performed as a standalone procedure, focusing on complication rates by surgical indication and age group. Design Retrospective population-based cohort. Setting British Columbia, Canada, from January 1st, 2008, to December 31st, 2022. Population 7102 people who received bilateral salpingectomies performed without concurrent surgical procedures. Methods International Disease Classification codes were used to identify the indication for bilateral salpingectomy. We compared outcomes for salpingectomy performed for prophylactic versus contraceptive indications, as well as across different age groups. Main Outcome Measures The primary outcome was a composite measure of complications assessed up from the index surgery to 6 weeks after discharge. We included admission to the intensive care unit, return to the operating room, in-hospital surgical complications, readmissions, and complications diagnosed during physician visits. Results There were 197 complications out of 7102 surgeries for bilateral salpingectomy corresponding to an overall complication rate of 2.8%. Complications occurred in 2.7% of procedures performed for contraception and 4.5% of those performed for prophylaxis, with no statistically significant difference between groups. There were also no significant differences in the adjusted risk ratios for same day discharge, postoperative complications, diagnostic imaging, or prescriptions for NSAIDs or opioids between indication groups. No significant differences in any of the measured outcomes were observed across age groups (< 35, 35-45, and > 45 years). Conclusion These results illustrate low complication rates in people undergoing bilateral salpingectomy as a standalone surgical procedure.

OBJECTIVE:Being a female with a germline BRCA1 or BRCA2 pathogenic variant (PV) elevates risks of developing breast and ovarian cancer, and guidelines recommend preventive interventions and increased screening. This study assesses the use of risk-reducing interventions. METHODS:This population-based retrospective study included all females who tested positive for a BRCA1/2 PV in British Columbia between 1996 and 2019. Using population-based administrative data, we analyzed their interactions with the health care system to ascertain use of risk-reducing interventions until December 31st, 2023. RESULTS:The final cohort included 1920 BRCA1/2 PV carriers. Of those without a prior breast cancer (n = 1021), 20.8% underwent bilateral mastectomy, with declining uptake in recent years. Of those who were within or above the NCCN-recommended age range for risk-reducing bilateral salpingo-oophorectomy (RRBSO) (n = 1342), 71.8% underwent RRBSO, and ∼ 5% underwent risk-reducing salpingectomy. Notably, only 25.4% of patients without a prior ovarian cancer diagnosis underwent surgical risk-reduction within the recommended age range (n = 318/1251). Delays were primarily due to late age at BRCA disclosure. Uptake of chemoprevention was low. After BRCA disclosure, 27 ovarian and 89 breast cancers were diagnosed. CONCLUSIONS:The uptake of mastectomy appears to be decreasing, while uptake of RRBSO for ovarian cancer remains high. However, disclosure of most BRCA PV's occurred after the age of recommended RRBSO, delaying their uptake of risk-reducing interventions and resulting in 24 possibly preventable ovarian cancers.

IntroductionStroke recurrence and vascular events remain major contributors to post-stroke mortality in India, where care is delivered through heterogeneous government and private healthcare systems. This post-hoc analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals.MethodsSPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models.ResultsAmong 4,298 randomized patients, 3,038 completed 1-year follow-up (59.8% private; 40.2% government). There was no significant difference was observed in the composite primary outcome between private and government institutions (2.8 vs. 3.7%; p = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index.ConclusionsStroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context.Clinical trial registrationhttp://ctri.nic.in, identifier: CTRI/2017/09/009600.

Objective There are widespread changes occurring in contraceptive use, with people moving away from oral contraceptive pills and toward intrauterine devices. Considerable data support the risk reduction for ovarian cancer with oral contraceptive use, but there is little evidence on how levonorgestrel intrauterine device use affects ovarian cancer risk. This paper examines ovarian cancer risk in levonorgestrel intrauterine device users in British Columbia, Canada, between 2002 and 2021. Methods This research used population-based data from British Columbia to analyze the risk of ovarian cancer in levonorgestrel intrauterine device users, compared with never users, while controlling for previous oral contraceptive use and age. Results The final cohort included 788,736 individuals, of whom 52,888 were exposed to the levonorgestrel intrauterine device. Exposed individuals were younger on average and were more likely to have used oral contraceptives. During follow-up, ovarian cancer was diagnosed in 17 exposed individuals and 1184 unexposed individuals. After adjustment for age and oral contraceptive use, levonorgestrel intrauterine device exposure was associated with a reduced risk of ovarian cancer (adjusted hazard ratio 0.57, 95% confidence interval 0.35 to 0.93). In an age-matched 1:1 cohort (n = 105,776), the association was similar but less precise (adjusted hazard ratio 0.61, 95% confidence interval 0.24 to 1.12). In a subgroup restricted to individuals older than 60 years by the end of follow-up (n = 211,866), based on 8 exposed and 720 unexposed ovarian cancer cases, levonorgestrel intrauterine device exposure was not associated with reduced ovarian cancer risk (adjusted hazard ratio 1.59, 95% confidence interval 0.79 to 3.21). Conclusions While the findings from the main cohort suggest that use of the levonorgestrel intrauterine device reduced the risk of ovarian cancer, this effect appeared to be confounded by age. These results should be interpreted with caution, as many levonorgestrel intrauterine device users are young and have not reached an age at which they are at a significant risk of ovarian cancer.

Background Perinatal depression and/or anxiety (depression-anxiety) have been associated with developmental disruptions. Less attention has been paid to preconception mental health, which could also contribute to adverse outcomes.Aims To examine whether preconception mental health is associated with developmental vulnerability in children who were either exposed or unexposed to prenatal depression.Method A population-based, retrospective cohort including 130 631 births to 108 340 pregnant people from British Columbia (Canada) between 1 January 2001 and 31 December 2012, with child development data in the form of the Early Development Instrument (EDI). Logistic regression using cluster-robust standard errors was used to compare the odds of vulnerability on EDI domains.Results Children born to pregnant people in all groups with depression-anxiety preconception history were more likely to be considered vulnerable on all developmental domains, except for communication skills and general knowledge, than those without prenatal depression and no preconception depression-anxiety. After adjusting for confounders, effect size was largest for children born to a person with prenatal depression who had persistent depression-anxiety before they conceived on the domains of physical health and well-being (adjusted odds ratio 1.73 [95% CI: 1.56-1.92]). Children born to people with prenatal depression but no preconception depression-anxiety were probably more vulnerable on social competence and emotional maturity domains than those without prenatal depression and no preconception depression-anxiety.Conclusions Preconception mental health is associated with child development, even after accounting for depression in pregnancy. We hypothesise that it is picking up on different experiences of mental illness through the life course and represents slightly different fetal exposures.

BACKGROUND:While postmenopausal bilateral salpingo-oophorectomy during benign hysterectomy may reduce the likelihood of adnexal surgeries and the risk of ovarian cancer, more evidence is needed to evaluate the health impacts of this procedure. Given the role of residual hormone secretion by postmenopausal ovaries, we hypothesize that performing bilateral oophorectomy at the time of benign hysterectomy among postmenopausal people may impact the risk of cardiovascular diseases and accelerated bone loss, both of which can significantly affect the quality of life in aging women. OBJECTIVE:To evaluate cardiovascular and bone health outcomes in people aged 50 to 60 years who did and did not undergo bilateral salpingo-oophorectomy at the time of hysterectomy. STUDY DESIGN:Retrospective population-based study using linked administrative data from British Columbia, Canada between Janaury 1, 1996 and September 30, 2019 with follow-up until December 31st, 2020. Multivariate Cox Proportional hazards models were used, adjusting for age at surgery, year of surgery, systemic menopausal hormone therapy use after surgery, and presence of baseline cardiovascular or bone health conditions up to 5 years before surgery, indication, and route of surgery. Subgroup analyses were conducted by stratifying individuals into early postmenopausal ages (50-55 years) and later postmenopausal ages (56-60 years). Statistical analyses were performed in R software version 4.0.3, STATA 16.1 (StataCorp) and SAS 9.4 (SAS Institute, Cary, NC) software. RESULTS:Of the 18,676 patients who remained in the study after applying exclusion criteria, 46.3% (n=8653) had hysterectomy with bilateral salpingo-oophorectomy. We observed no statistically significant difference in cardiovascular composite event outcomes (congestive heart failure, myocardial infarction, cerebral vascular disease, and ischemic heart disease) and cardiovascular procedure outcomes (percutaneous coronary intervention, coronary artery bypass, or cardiac catheterization) across the groups. Nevertheless, patients who had concurrent oophorectomy were at a higher risk of being diagnosed with conditions that predispose them to cardiovascular diseases, such as diabetes and hypertension (adjusted hazard ratio, 1.16; 95% confidence interval, 1.08-1.25), and were also more likely to be prescribed cardiovascular medications (adjusted hazard ratio, 1.07; 95% confidence interval, 1.00-1.15). No significant differences were observed between the groups in terms of osteoporosis, fractures, or initiating osteoporosis medication after adjustment for covariates. The likelihood of starting menopausal hormone therapy after surgery was significantly higher for those who had hysterectomy with bilateral oophorectomy compared to hysterectomy with ovarian conservation (adjusted hazard ratio, 2.04; 95% confidence interval, 1.92-2.17). Results mostly remained consistent in the subgroup analyses, especially among participants aged 50 to 55 years. CONCLUSION:Our study revealed that although removing postmenopausal ovaries at the time of benign hysterectomy is not associated with an increased risk of adverse cardiovascular or bone health-related outcomes, it might be associated with an increased risk of cardiovascular disease predisposing conditions and the need for prescribing medications for those conditions and hormone therapy. This could indicate a benefit for retaining postmenopausal ovaries at the time of benign hysterectomy among postmenopausal patients. Given the existing variation in practice, pragmatic trials are recommended to inform the decisions on performing oophorectomy in an average-risk population.

OBJECTIVE:The association of hormone therapy (HT) combined with statin use for primary prevention of cardiovascular disease remains uncertain. This study aimed to assess the effect of HT, initiated before the age of 60 years, on all-cause mortality and cardiovascular events in females using statins for primary prevention. METHOD:This population-based, retrospective cohort study included all females aged 40-60 years in British Columbia, Canada, who used statins for primary prevention. The exposure was defined as systemic HT, including estrogen alone or combined with a progestogen, excluding local preparations of estrogen. The study used Cox proportional hazards models from the study start date to the outcome. RESULTS:After exact matching on age using up to a 1-to-4 match, 685 (20%) of the 3,425 statin users initiated HT within the first year of follow-up. HT use was not significantly associated with all-cause mortality after adjusting for confounders (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 0.87-1.58). Similarly, for the secondary outcome of composite cardiovascular events, HT use did not significantly increase risk (aHR, 0.95; 95% CI, 0.75-1.20). CONCLUSION:This study found that HT, when initiated before age 60 years, was not associated with an increased risk of all-cause mortality or cardiovascular events in females using statins for primary prevention.

The risk of psychiatric hospitalization increases in the year postpartum, and rates have been rising. However, data describing these admissions is limited. In this retrospective, population-based study of all deliveries between 2015-2019 in British Columbia (BC), Canada, we linked BC perinatal data registry with other health services data, including all hospital admissions. Rates, characteristics, and risk factors for postpartum psychiatric hospital admissions were analyzed using descriptive statistics and logistic regression modeling. Following 189,530 deliveries, there were 812 postpartum psychiatric admissions (∼4/1000 deliveries). The most common indications for postpartum admission were depression (n=233[28.7%]) and substance-related disorders (n=234[28.8%]). These hospitalizations were short (median=3 days, IQR(Q1-Q3)=1-8), and relatively late (median=5.5 months postpartum, IQR(Q1-Q3)=68.5-251 days). Hospitalizations for psychosis and bipolar disorder occurred much later than expected (psychosis: median=111 days postpartum (IQR=32-213); bipolar disorder: median=118 days (IQR=42-230)). The risk factors most associated with these admissions were younger age, especially age<20 (aOR=5.01, 95% CI:3.60-6.98), receiving treatment for schizophrenia during pregnancy (aOR=4.21, 95% CI:2.42-7.34), and a psychiatric diagnosis during pregnancy (aOR=3.58, 95% CI:2.30-5.58). These results show that those at high risk of severe postpartum psychiatric illness were young, took antidepressants during pregnancy, and had a recent psychiatric illness. This knowledge could support early intervention and avoid the need for hospitalization. This research should be replicated and expanded to explore gaps in the healthcare system for severe postpartum psychiatric illness.

The purpose of this study is to evaluate the effectiveness of opportunistic salpingectomy (OS), a procedure that aims to remove only the fallopian tubes of general population risk women, for the prevention of epithelial ovarian cancer. Currently, the method of prevention for individuals at high risk of ovarian cancer involves a bilateral salpingo-oophorectomy (BSO), a procedure that removes both the fallopian tubes and ovaries. However, this procedure is not recommended for individuals of the general population, who make up about 80% of ovarian cancers, due to negative health implications to the cardiovascular and skeletal systems because of surgically induced menopause. The effectiveness of the OS in preventing ovarian cancers and how the procedure impacts the histotype distribution of ovarian cancers remains unknown. This study uses a population-based approach and a case-based approach to determine the effectiveness of OS and its impact on histotype distribution, respectively. For the population-based analysis, we will search through clinical databases to acquire cases of individuals who have had an OS and a tumor. A control population who have their fallopian tubes in-tact will also be acquired. A cox-proportional hazard analysis will be performed to determine the effectiveness of the procedure. Using pathological records, the case-based ascertainment of tumors from individuals who have had an OS will be selected and reviewed for histotype confirmation. Fallopian tubes of these patients will also be reviewed for precursor lesions. This cohort will be compared to a historical histotype distribution of ovarian cancers. For the population-based approach, we have to date, identified less than five serous ovarian cancers in individuals who have had an OS (n=40, 477). A comparator surgery was used as a control and showed 21 cancers. For the case-based approach, we have partnered with 23 collaborating institutions from around the world to identify tumors in individuals who have had an OS. We have identified 26 epithelial ovarian cancers, with the most lethal gynecological histotype, high grade serous carcinoma (HGSC), accounting for 23.1% of the total proportion of epithelial ovarian cancer cases (n=6/26). This is significantly less than the historical histotype distribution of HGSC, which is 69.3% (Fisher’s exact test, p<0.0001). One HGSC case had a precursor lesion called a serous tubal intraepithelial carcinoma (STIC) while reviewing fallopian tubes of this individual. TP53 mutation analysis on one HGSC tumor sample showed a frameshift mutation in TP53 (c229fs) with the tumor and the corresponding STIC staining negative for p53 protein expression by immunohistochemistry. This evidence demonstrates the effectiveness of opportunistic salpingectomy for the prevention of ovarian cancer and shows a histotype distribution shift, with the most lethal gynecological malignancy having a significant reduction in cases following the procedure. Ramlogan Sowamber, Alice J. Mei, Paramdeep Kaur, Julianne McLeod, Emily McKay, Alex Lukey, Jamie Bakkum-Gamez, Natalia Buza, Paul Cohen, Kyle Devins, Rhonda Farrell, Christine Garcia, Blake Gilks, Ellen Goode, Anjelica Hodgson, Brooke Howitt, Pei Hui, Jutta Huvila, Anthony Karnezis, Kianoosh Keyhanian, Mary Kinloch, Martin Köbel, Felix KF. Kommoss, Lawrence Kushi, Janice S. Kwon, Kara Long-Roche, Anais Malpica, Jessica N. McAlpine, Dianne Miller, Esther Oliva, Andrea Palicelli, Aleksandra Paliga, Carlos Parra-Herran, Celeste Leigh Pearce, Sharnel Perera, Jurgen M. Piek, Haiyan Qiu, Joseph Rabban, Robert Rome, Miranda Steenbeek, Rebecca Stone, Aline Talhouk, Kristin M. Tischer, Britton Trabert, Penelope M. Webb, John R. Zalcberg, Gillian E. Hanley, David G. Huntsman. Evaluating the effectiveness of opportunistic salpingectomy (OS) for the prevention of epithelial ovarian cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Ovarian Cancer Research; 2025 Sep 19-21; Denver, CO. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl):Abstract nr B045.

PURPOSE:Given the increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses and stimulant medication use among female adults, this study describes the prevalence trends of perinatal ADHD stimulant medication use in British Columbia, Canada, along with characteristics and patterns of use. METHODS:Using linked population-based administrative data, we included all pregnant people with deliveries between January 2000 and December 2021. ADHD stimulant medication use was defined as filled prescriptions for dextro-/amphetamine, methylphenidate, or lisdexamfetamine. Prevalence trends were examined by medication type and age group. Characteristics were compared between those with and without prenatal stimulant medication dispensations. Patterns of use and discontinuation were assessed from 1 year preconception to 1 year postpartum. RESULTS:Our cohort included 899,679 pregnancies. Prenatal ADHD stimulant medication use increased by 3.9 users per 1000 pregnancies (from 0.4 to 4.3/1000), primarily driven by dextro-/amphetamine. Medication use increased among all age groups, but was highest among pregnant people under 20 years old. Pregnant people taking stimulant medications were more likely to be nulliparous and lower in income, have hypertension and higher BMI, smoke during pregnancy, use other psychotropic medications, and deliver by cesarean section. Among those who used stimulant medications within 1 year preconception, 77% discontinued treatment before or during pregnancy. While use increased again within 12 months postpartum, it remained 45% lower than preconception levels. CONCLUSION:The 11-fold increase in ADHD stimulant medication use during pregnancy and the high rate of discontinuation highlight the need for more research on the risks and benefits of medication for parent and child health.

OBJECTIVES:The objective of this study is to compare the vaginal uncomplicated delivery (VUD) rate, defined as all vaginal deliveries (including forceps and vacuum) without an adverse maternal or neonatal labour outcome, to the cesarean delivery (CD) rate, as a performance indicator. METHODS:This is a retrospective cohort analysis from a provincial database of all term deliveries by an obstetrician in a single year, excluding diagnoses preventing active labour. Most obstetricians in this jurisdiction practice consultative obstetrics, focused on supporting primary maternity care. We investigated the association of adverse delivery (AD), measured by the adverse outcome index, with CD and VUD rates. RESULTS:We report 16 620 deliveries by 210 obstetricians, with a vaginal delivery rate of 39.6%, of which 36.6% were operative vaginal delivery. The overall AD rate was 9.9%, and the overall VUD rate was 34%. While the CD and VUD both correlated with the mode of delivery, only the VUD rate was correlated to the AD rate. CONCLUSIONS:Quality assurance in obstetrics must balance the needs of 2 patients based on limited data. Our data shows the shortcomings of the prevailing performance indicator, CD rate, which does not correlate with birth outcomes for the pregnant patient or infant. The VUD rate provides an alternative that assesses both mode of delivery and labour outcomes. Shifting the quality lens to focus on the VUD rate will provide a better metric that measures optimal outcomes for pregnant people and their babies.

OBJECTIVES:Opportunistic salpingectomy (OS) is the removal of fallopian tubes during another pelvic surgery for the purpose of ovarian cancer prevention. Herein, we describe the rates of OS at the time of hysterectomy and tubal sterilization between 2017 and 2020. METHODS:This study uses the Canadian Institute of Health Information's Discharge Abstract Database and National Ambulatory Care Reporting System for all Canadian provinces and territories except for Quebec between the fiscal years 2017 and 2020. A descriptive analysis on all people aged 15 years and older who had hysterectomies or tubal sterilizations was conducted to determine the proportion of hysterectomies that included bilateral salpingectomy (OS) and the proportion of tubal sterilizations that were OS compared to tubal ligation. RESULTS:There were 174 006 people included in the study. The proportion of hysterectomies that included OS increased from 31.7% in 2017 to 39.9% by 2020. With respect to tubal sterilizations, rates of OS increased from 26.3% of all tubal sterilizations in 2017 to 42.5% in 2020. British Columbia remained the jurisdiction with the highest rates of OS, but rates increased significantly in many jurisdictions, particularly at the time of tubal sterilization. CONCLUSION:The rates of OS have continued to increase in all Canadian jurisdictions following the official Society of Obstetricians and Gynaecologists of Canada recommendation to consider OS in 2015. Assuming that all tubal ligations could have been OS and 75% of hysterectomies with ovarian conservation could have included OS, our data indicate 76 932 missed opportunities for ovarian cancer prevention.

generalized estimating equations using log-binomial models respectively at multi-ple timepoints. Results: Case-fatality rate was 33% at 1 month, 43% at 1 year, and 47% at 5 years. Poor functional outcome was present in 27% of survivors at 1 month and 15% at 1 year. In multivariable analysis, predictors of death at 1-month were age (per decade increase MRR 1.14 [1.07-1.22]) and SAH severity (MRR 1.87 [1.50-2.33]); at 1 year were age (MRR 1.53 [1.34-1.56]), current smoking (MRR 1.82 [1.20-2.72]) and SAH severity (MRR 3.00 [2.06-4.33]) and; at 5 years were age (MRR 1.63 [1.45-1.84]), current smoking (MRR 2.29 [1.54-3.46]) and severity of SAH (MRR 2.10 [1.44-3.05]). Predictors of poor functional outcome at 1 month were age (per decade increase RR 1.32 [1.11-1.56]) and SAH severity (RR 1.85 [1.06-3.23]), and SAH sever-ity (RR 7.09 [3.17-15.85]) at 1 year. Conclusion: Although age is a non-modifiable risk factor for poor outcomes after SAH, however, severity of SAH and smoking are potential targets to improve the outcomes.

BACKGROUND: More research is needed that compares the outcomes between those who underwent a hysterectomy for endometriosis with conservation of one or both ovaries and those who underwent a hysterectomy with bilateral salpingo-oophorectomy.OBJECTIVE: This study aimed to compare the rate and types of reoperations (primary outcome) and use of other pain-related health services (secondary outcomes) among people who underwent a hysterectomy with conservation of both ovaries, those who underwent a hysterectomy with unilateral salpingo-oophorectomy, and those who underwent a hysterectomy with bilateral salpingo-oophorectomy.STUDY DESIGN: This was a population-based, retrospective cohort study of 4489 patients aged 19 to 50 years in British Columbia, Canada, who underwent a hysterectomy for endometriosis between 2001 and 2016. Index surgeries were classified as hysterectomy alone (conservation of both ovaries), hysterectomy with unilateral salpingo-oophorectomy, or hysterectomy with bilateral salpingo-oophorectomy. Reoperation rate was the primary outcome. Secondary outcomes (measured at 3-12 months and 1-5 years after hysterectomy) included physician visits for endometriosis and pelvic pain, prescriptions filled for opioids, and use of hormonal suppression medications and hormone replacement therapy.RESULTS: Reoperation rates were low across all groups, with 89.5% of all patients remaining reoperation free by the end of follow-up (median of 10 years; interquartile range, 6.1-14.3 years). Patients who underwent a hysterectomy alone were more likely to undergo at least 1 reoperation when compared with those who underwent a hysterectomy with bilateral salpingo-oophorectomy (13% vs 5%; P<.0001), most commonly an oophorectomy or adhesiolysis. When oophorectomy as reoperation was removed in a sensitivity analysis, this difference was partially attenuated (6% of hysterectomy alone group vs 3% of hysterectomy with bilateral salpingo-oophorectomy group undergoing at least 1 reoperation). All groups were very similar in terms of rates of physician visits for endometriosis or pelvic pain and the number of days of opioid prescriptions filled. Furthermore, the rate of hormonal suppression medication use was similar among the groups, whereas the rate of prescriptions filled for hormone replacement therapy after hysterectomy with bilateral salpingooophorectomy was 60.6% of patients who filled at least 1 prescription at 3 to 12 months after index surgery.CONCLUSION: Patients who underwent a hysterectomy with bilateral salpingo-oophorectomy had a lower reoperation rate than those who underwent a hysterectomy with conservation of one or both ovaries. However, there was little difference between the groups for the secondary outcomes measured, including physician visits for endometriosis and pelvic pain, opioid use, and use of hormonal suppression medications, suggesting that persistent pelvic pain after hysterectomy for endometriosis may not differ substantively based on ovarian conservation status. One limitation was the inability to stratify patients by stage of endometriosis or to determine the impact of endometriosis stage or the presence of adnexal disease or deep endometriosis on the outcomes. Moreover, hormone replacement therapy prescriptions was not filled by about 40% of patients after hysterectomy with bilateral salpingo-oophorectomy, which may have significant health consequences for these individuals undergoing premature surgical menopause. Therefore, strong consideration should be given to ovarian conservation at the time of hysterectomy for endometriosis.

To evaluate pain-related health services use after hysterectomy for endometriosis with or without unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy (BSO), with respect to rates and types of reoperation, physician visits, and subsequent opioid and hormone prescriptions.

Objective: The objective of the study was to determine incidence, risk factors, and short-term outcomes of young stroke in Ludhiana city, Northwest India. Methods: Data were collected on first-ever stroke in patients of age ≥18 years, from hospitals, diagnostic imaging centers, general practitioners, and municipal corporation during March 2011–March 2013 in Ludhiana city, using the World Health Organization Stepwise Approach to Surveillance (WHO STEPS). Outcome was documented using the modified Rankin Scale at 28 days. Results: Of 2948 patients, 700 (24%) were in the age group 18–49 years. Annual incidence in this age group was 46/100,000 person-years (95% confidence interval [CI], 41–51/100,000). Hypertension (84%), diabetes mellitus (48%), and atrial fibrillation (AF) (12%) were found more common in >49 years age group, as compared with 18–49 years age group. Drug abuse (8.7% vs. 6% in age >49 years; P = 0.04) and tobacco intake (8.7% vs. 5.6% in age >49 years; P = 0.02) was more common in young people, that is, 18–49 years age group in comparison to older patients, >49 years age group. Recovery was better in younger subjects (60% vs. 46% in age >49 years P < 0.001). In a multivariable analysis, younger people were more often literate (odds ratio [OR] 2.52; 95% CI, 1.68–3.77; P < 0.001), employed (OR 3.92; 95% CI, 2.20–5.21; P < 0.001), and 374 (60%) had good clinical outcome, modified Rankin Scale <2 at 28 days follow-up as compared with 938 (46%) older patients (OR 1.52; 95% CI, 1.15–2.00; P = 0.003). Conclusion: Hypertension, diabetes mellitus, drug addiction, and tobacco intake were significantly associated with young stroke. Outcome was also better in younger people.