For a study, researchers sought to use updated Markov modeling to determine the best age for bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign causes. They conducted a study of the literature to determine the hazard ratios (HRs) for death by illness, age, hysterectomy with or without BSO, and estrogen treatment usage. National vital statistics data were used to calculate the base mortality rates. A Markov model based on published HRs projected the proportion of the population living to age 80 by 1-year and 5-year age groups at the time of operation, ranging from 45 to 55 years. Those under the age of 50 were modeled as either getting or not receiving postoperative estrogen, while those 50 and over were represented as not receiving estrogen. R 3.5.1 was used for the computations, using Bayesian integration for HR uncertainty.

Salpingo-oophorectomy performed before the age of 50 in women who were not taking estrogen resulted in a lower proportion of women living to the age of 80 than hysterectomy alone performed before the age of 50 (52.8% [Bayesian CI 40.7–59.7] versus 63.5% [Bayesian CI 62.2–64.9]). At or after the age of 50, there were similar proportions of individuals living to the age of 80 with hysterectomy alone (66.4%, Bayesian CI 65.0–67.6) vs concomitant salpingo-oophorectomy (66.9%, Bayesian CI 64.4–69.0). Importantly, those who were taking estrogen when their salpingo-oophorectomy was performed before the age of 50 had the same proportions of cardiovascular disease, stroke, and people living to the age of 80 as those who had hysterectomy alone or hysterectomy and salpingo-oophorectomy at the age of 50 and older.

The revised Markov model argued for the possibility of concurrent salpingo-oophorectomy for patients aged 50 and older having a hysterectomy and implied that commencing estrogen in patients who require salpingo-oophorectomy before the age of 50 years reduces the risk of increased death.