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Article ; Online: Frequency and type of premature or early menopause in a geographically defined American population.

Rocca, Walter A / Gazzuola Rocca, Liliana / Smith, Carin Y / Kapoor, Ekta / Faubion, Stephanie S / Stewart, Elizabeth A

2023 Volume 170, Page(s) 22–30

Abstract: Objective: There is limited information on the prevalence of premature and early menopause. Therefore, we studied the frequency and type of premature (age < 40 years) or early (age 40-44 years) menopause in a geographically-defined American population.!# ...

Abstract	Objective: There is limited information on the prevalence of premature and early menopause. Therefore, we studied the frequency and type of premature (age < 40 years) or early (age 40-44 years) menopause in a geographically-defined American population. Methods: We studied a random sample of women aged 18 to 50 years who resided in Olmsted County, MN between 1988 and 2007. Women were followed through December 2021, and age at cessation of menses was assessed via review of the medical records included in a medical records-linkage system. Menopause was defined as cessation of menses due to spontaneous or induced ovarian insufficiency. Results: 1015 women (71.3 %) underwent spontaneous menopause, 138 (9.7 %) underwent bilateral oophorectomy, 17 (1.2 %) had antecedent chemotherapy or radiation therapy, and 254 (17.8 %) underwent hysterectomy or endometrial ablation. The median age at cessation of menses was 51.0 years (IQR, 49.0-52.0) for spontaneous menopause, 46.0 years (IQR, 41.0-49.0) for menopause induced by oophorectomy, chemotherapy, or radiation therapy, and 38.0 years (IQR, 33.0-44.0) for hysterectomy. Considering both spontaneous and induced menopause, the frequency was 3.1 % (95 % CI, 2.2-4.2) for premature and 6.2 % (95 % CI, 5.0-7.8) for early menopause. Considering only spontaneous menopause, the frequency reduced to 0.4 % (95 % CI, 0.2-1.0) for premature and 5.2 % (95 % CI, 4.0-6.8) for early menopause. However, considering all types of cessations of menses, the frequency was 12.2 % (95 % CI, 10.6-14.0) for premature and 9.7 % (95 % CI, 8.3-11.3) for early cessation of menses. Discussion: Approximately 3 % of women in the general population experienced either spontaneous or induced premature menopause. The most common cause of premature menopause was bilateral oophorectomy.
MeSH term(s)	Female ; Humans ; Menopause, Premature ; Risk Factors ; Menopause ; Primary Ovarian Insufficiency ; Ovariectomy ; Minnesota/epidemiology
Language	English
Publishing date	2023-02-06
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	80460-5
ISSN	1873-4111 ; 0378-5122
ISSN (online)	1873-4111
ISSN	0378-5122
DOI	10.1016/j.maturitas.2023.01.012
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Article ; Online: Association of Premenopausal Bilateral Oophorectomy With Parkinsonism and Parkinson Disease.

Rocca, Walter A / Smith, Carin Y / Gazzuola Rocca, Liliana / Savica, Rodolfo / Mielke, Michelle M

JAMA network open

2022 Volume 5, Issue 10, Page(s) e2238663

Abstract: Importance: The association of premenopausal bilateral oophorectomy with parkinsonism and Parkinson disease (PD) remains controversial.: Objective: To assess whether women who underwent premenopausal bilateral oophorectomy were at increased risk of ... ...

Abstract	Importance: The association of premenopausal bilateral oophorectomy with parkinsonism and Parkinson disease (PD) remains controversial. Objective: To assess whether women who underwent premenopausal bilateral oophorectomy were at increased risk of parkinsonism and PD and whether the associations varied by age at oophorectomy and by receipt of estrogen replacement therapy. Design, setting, and participants: This cohort study used data from a combination of 2 independent cohort studies, the Mayo Clinic Cohort Study of Oophorectomy and Aging 1 and 2, which were based on the Rochester Epidemiology Project medical records-linkage system. A population-based sample of 5499 women from Olmsted County, Minnesota, were included; of those, 2750 women underwent bilateral oophorectomy for a benign indication before spontaneous menopause between January 1, 1950, and December 31, 2007 (oophorectomy cohort), and 2749 age-matched women who did not undergo bilateral oophorectomy were randomly sampled from the general population (reference cohort). Data were analyzed from March 1 to April 30, 2022. The date of oophorectomy was considered the index date for both groups. Exposures: Medical record documentation of bilateral oophorectomy abstracted from a medical records-linkage system (Rochester Epidemiology Project). Main outcomes and measures: Incidence and risk of parkinsonism or PD, with diagnoses confirmed by in-person examination or medical record review. Results: Among 5499 participants (median [IQR] age, 45.0 [40.0-48.0] years; 5312 [96.6%] White), 2750 women (2679 White [97.4%]) underwent bilateral oophorectomy at a median age of 45.0 years (IQR, 40.0-48.0 years), and 2749 women (2633 White [95.8%]) with a median age of 45.0 years (IQR, 40.0-48.0 years) at the index date were included in the reference cohort. Bilateral oophorectomy was associated with an increased risk of parkinsonism overall (hazard ratio [HR], 1.59; 95% CI, 1.02-2.46) and in women younger than 43 years at oophorectomy (HR, 7.67; 95% CI, 1.77-33.27). There was a pattern of increasing risk with younger age at the time of oophorectomy using 4 age strata (≥50 years: HR, 1.43 [95% CI, 0.50-4.15]; 46-49 years: HR, 1.55 [95% CI, 0.79-3.07]; 40-45 years: HR, 1.36 [95% CI, 0.64-2.89]; <40 years: HR, 8.82 [95% CI, 1.08-72.00]; P = .02 for trend). The number needed to harm was 53 women overall and 27 women younger than 43 years at the time of oophorectomy. Bilateral oophorectomy was also associated with an increased risk of PD in women younger than 43 years at oophorectomy (HR, 5.00; 95% CI, 1.10-22.70), with a number needed to harm of 48 women. Among women who underwent oophorectomy at 45 years and younger, the risk was lower in women who received estrogen after the procedure and through age 50 years compared with women who did not. For parkinsonism, the HRs were 1.72 (95% CI, 0.54-5.53) vs 2.05 (95% CI, 0.80-5.23); for PD, the HRs were 1.53 (95% CI, 0.29-8.23) vs 2.75 (95% CI, 0.84-9.04). However, the differences were not significant. Conclusions and relevance: In this study, premenopausal women who underwent bilateral oophorectomy before age 43 years had an increased risk of parkinsonism and PD compared with women who did not undergo bilateral oophorectomy. These findings suggest that a reduction in the practice of prophylactic bilateral oophorectomy in premenopausal women at average risk of ovarian cancer may have substantial benefit for reducing the risk of parkinsonism and PD.
MeSH term(s)	Humans ; Female ; Adult ; Middle Aged ; Cohort Studies ; Parkinson Disease/epidemiology ; Age Factors ; Risk Factors ; Ovariectomy/adverse effects ; Estrogens
Chemical Substances	Estrogens
Language	English
Publishing date	2022-10-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.38663
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Article ; Online: Smoking, early menopause and multiple sclerosis disease course.

Neyal, Nur / Atkinson, Elizabeth J / Smith, Carin Y / Weis, Delana M / Gazzuola Rocca, Liliana / Rocca, Walter A / Kantarci, Kejal / Kantarci, Orhun H / Zeydan, Burcu

Climacteric : the journal of the International Menopause Society

2023 Volume 26, Issue 6, Page(s) 560–564

Abstract: Smoking is associated with an increased risk of multiple sclerosis (MS), and smoking and early menopause are related to poor outcomes in MS. Smoking is also associated with early menopause. To explore this intricate relationship between smoking status, ... ...

Abstract	Smoking is associated with an increased risk of multiple sclerosis (MS), and smoking and early menopause are related to poor outcomes in MS. Smoking is also associated with early menopause. To explore this intricate relationship between smoking status, age at menopause and disease course in MS, 137 women with MS and 396 age-matched controls were included in this case-control study. Age at menopause (median 49.0 vs. 50.0 years;
MeSH term(s)	Humans ; Female ; Multiple Sclerosis/epidemiology ; Multiple Sclerosis/etiology ; Case-Control Studies ; Risk Factors ; Smoking/adverse effects ; Menopause, Premature ; Menopause ; Disease Progression
Language	English
Publishing date	2023-06-30
Publishing country	England
Document type	Journal Article
ZDB-ID	1469153-x
ISSN	1473-0804 ; 1369-7137
ISSN (online)	1473-0804
ISSN	1369-7137
DOI	10.1080/13697137.2023.2221381
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Article ; Online: Risk of de novo cancer after premenopausal bilateral oophorectomy.

Huo, Nan / Smith, Carin Y / Gazzuola Rocca, Liliana / Rocca, Walter A / Mielke, Michelle M

American journal of obstetrics and gynecology

2021 Volume 226, Issue 4, Page(s) 539.e1–539.e16

Abstract: Background: Hysterectomy is one of the most frequent gynecologic surgeries in the United States. Women undergoing hysterectomy are commonly offered bilateral oophorectomy for ovarian and breast cancer prevention. Although bilateral oophorectomy may ... ...

Abstract	Background: Hysterectomy is one of the most frequent gynecologic surgeries in the United States. Women undergoing hysterectomy are commonly offered bilateral oophorectomy for ovarian and breast cancer prevention. Although bilateral oophorectomy may dramatically reduce the risk of gynecologic cancers, some studies suggested that bilateral oophorectomy may be associated with an increased risk of other types of cancer, such as lung cancer and colorectal cancer. However, the results are conflicting. Objective: To study the association between bilateral oophorectomy and the risk of subsequent cancer of any type. Study design: This population-based cohort study included all premenopausal women who underwent bilateral oophorectomy for a nonmalignant indication before the age of 50, between January 1, 1988 and December 31, 2007 in Olmsted County, Minnesota, and a random sample of age-matched (±1 year) referent women who did not undergo bilateral oophorectomy. Women with cancer before oophorectomy (or index date) or within 6 months after the index date were excluded. Time-to-event analyses were performed to assess the risk of de novo cancer. Cancer diagnosis and type were confirmed using medical record review. Results: Over a median follow-up of 18 years, the risk of any cancer did not significantly differ between the 1562 women who underwent bilateral oophorectomy before natural menopause and the 1610 referent women (adjusted hazard ratio, 0.82; 95% confidence interval, 0.66-1.03). However, women who underwent bilateral oophorectomy had a decreased risk of gynecologic cancers (adjusted hazard ratio, 0.15; 95% confidence interval, 0.06-0.34) but not of nongynecologic cancers (adjusted hazard ratio, 0.99; 95% confidence interval, 0.78-1.26). In particular, the risk of breast cancer, gastrointestinal cancer, and lung cancer did not differ between these 2 cohorts. Use of estrogen therapy through the age of 50 years in women who underwent bilateral oophorectomy did not modify the results. Conclusion: Women who underwent bilateral oophorectomy before menopause have a reduced risk of gynecologic cancer but not of other types of cancer including breast cancer. Women at average risk of ovarian cancer should not consider bilateral oophorectomy for the prevention of breast cancer or other nongynecologic cancers.
MeSH term(s)	Cohort Studies ; Female ; Humans ; Hysterectomy/methods ; Middle Aged ; Ovarian Neoplasms/prevention & control ; Ovariectomy/adverse effects ; Premenopause ; Risk Factors
Language	English
Publishing date	2021-11-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2021.10.040
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Article ; Online: A population-based cohort study on the risk of obstructive lung disease after bilateral oophorectomy.

Nguyen, Trinh T / Smith, Carin Y / Gazzuola Rocca, Liliana / Rocca, Walter A / Vassallo, Robert / Dulohery Scrodin, Megan M

NPJ primary care respiratory medicine

2022 Volume 32, Issue 1, Page(s) 52

Abstract: There is increasing evidence that sex hormones may impact the development of obstructive lung disease (OLD). Therefore, we studied the effect of bilateral oophorectomy (oophorectomy) on the development of OLD. Women were identified from the Mayo Clinic ... ...

Abstract	There is increasing evidence that sex hormones may impact the development of obstructive lung disease (OLD). Therefore, we studied the effect of bilateral oophorectomy (oophorectomy) on the development of OLD. Women were identified from the Mayo Clinic Cohort Study of Oophorectomy and Aging-2. Data were collected using the Rochester Epidemiology Project records-linkage system. A total of 1653 women who underwent oophorectomy and 1653 referent women of similar age were assessed for OLD using diagnostic codes and medical record abstraction. Women who underwent oophorectomy had an overall higher risk of all OLD, all chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis but not of all asthma, confirmed asthma, or confirmed COPD. The association with all OLD was stronger in women who were age ≤45 years at oophorectomy, never smokers, non-obese, and in women with benign indications; however, the interactions were not statistically significant. There was an increased risk of all asthma in women age ≤45 years at oophorectomy who took estrogen therapy. Never smokers of all ages had a stronger association of oophorectomy with all asthma and all COPD, whereas smokers had a stronger association of oophorectomy with emphysema and chronic bronchitis. Non-obese women of all ages had a stronger association of oophorectomy with all COPD, emphysema, and chronic bronchitis. The results of this study combined with the increased risk of several chronic diseases reported in previous studies suggest that oophorectomy in premenopausal women should be avoided unless there is clear evidence of a high genetic risk of ovarian cancer.
MeSH term(s)	Female ; Humans ; Middle Aged ; Cohort Studies ; Bronchitis, Chronic/etiology ; Ovariectomy/adverse effects ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Risk Factors ; Asthma/epidemiology ; Asthma/etiology ; Emphysema/etiology
Language	English
Publishing date	2022-11-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2780812-9
ISSN	2055-1010 ; 2055-1010
ISSN (online)	2055-1010
ISSN	2055-1010
DOI	10.1038/s41533-022-00317-4
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Article ; Online: Association of Premenopausal Bilateral Oophorectomy With Restless Legs Syndrome.

Huo, Nan / Smith, Carin Y / Gazzuola Rocca, Liliana / Rocca, Walter A / Mielke, Michelle M

JAMA network open

2021 Volume 4, Issue 2, Page(s) e2036058

Abstract: Importance: Restless legs syndrome is a common neurologic disorder that is more prevalent in women than in men, and it has been suggested that female hormones may be involved in the disorder's pathophysiology.: Objective: To determine whether women ... ...

Abstract	Importance: Restless legs syndrome is a common neurologic disorder that is more prevalent in women than in men, and it has been suggested that female hormones may be involved in the disorder's pathophysiology. Objective: To determine whether women who underwent premenopausal bilateral oophorectomy were at increased risk of restless legs syndrome. Design, setting, and participants: This cohort study was performed using data from the Mayo Clinic Cohort Study of Oophorectomy and Aging-2 for a population in Olmsted County, Minnesota. There were 1653 women who underwent premenopausal bilateral oophorectomy before the age of 50 years for a benign indication between 1988 and 2007 and 1653 age-matched women (of same age plus or minus 1 year) in a reference group. Follow-up was conducted until the end of the study period (ie, December 31, 2014). Data were analyzed from January to July 2020. Exposures: Undergoing bilateral oophorectomy, as shown in medical record documentation. Main outcomes and measures: Diagnosis of restless legs syndrome, as defined using Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, was recorded. Results: Among 3306 women, the median (interquartile range) age at baseline was 44.0 (40.0-47.0) years. Women who underwent bilateral oophorectomy, compared with women who did not undergo this procedure, had a greater number of chronic conditions at the index date (eg, 300 women [18.1%] vs 171 women [10.3%] with ≥3 chronic conditions; overall P < .001), were more likely to have obesity (576 women [34.8%] vs 442 women [27.1%]; overall P < .001), and were more likely to have a history of anemia of any type (573 women [34.7%] vs 225 women [13.6%]; P < .001), iron deficiency anemia (347 women [21.0%] vs 135 women [8.2%]; P < .001), and restless legs syndrome before the index date (32 women [1.9%] vs 14 women [0.8%]; P = .008). Women who underwent bilateral oophorectomy prior to natural menopause had a higher risk of restless legs syndrome after the index date compared with women in the reference group (120 diagnoses vs 74 diagnoses), with an adjusted hazard ratio (HR) of 1.44 (95% CI, 1.08-1.92; P = .01). After stratification by indication for the bilateral oophorectomy, there was an increased risk of restless legs syndrome among women without a benign ovarian condition (HR, 1.52; 95% CI, 1.03-2.25; P = .04) but not among women with a benign condition (HR, 1.25; 95% CI, 0.80-1.96; P = .34). Treatment with estrogen therapy through the age of 46 years in women who underwent bilateral oophorectomy at younger ages was not associated with a difference in risk. Conclusions and relevance: This cohort study found that risk of restless legs syndrome was increased among women who underwent bilateral oophorectomy prior to menopause, especially those without a benign ovarian indication.
MeSH term(s)	Adult ; Anemia/epidemiology ; Case-Control Studies ; Estrogen Replacement Therapy/statistics & numerical data ; Female ; Humans ; Hysterectomy/statistics & numerical data ; Middle Aged ; Obesity/epidemiology ; Ovarian Diseases/epidemiology ; Ovarian Diseases/surgery ; Ovariectomy/statistics & numerical data ; Premenopause ; Proportional Hazards Models ; Restless Legs Syndrome/epidemiology ; Risk Factors
Language	English
Publishing date	2021-02-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2020.36058
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Article ; Online: Trajectories of metabolic parameters after bilateral oophorectomy in premenopausal women.

Kapoor, Ekta / Faubion, Stephanie S / Gazzuola Rocca, Liliana / Mielke, Michelle M / Smith, Carin Y / Rocca, Walter A

Maturitas

2022 Volume 165, Page(s) 38–46

Abstract: Objective: To study the trajectories of metabolic parameters after bilateral oophorectomy.: Study design: This population-based cohort study included a random sample of all premenopausal women who underwent bilateral oophorectomy at or before age 45 ... ...

Abstract	Objective: To study the trajectories of metabolic parameters after bilateral oophorectomy. Study design: This population-based cohort study included a random sample of all premenopausal women who underwent bilateral oophorectomy at or before age 45 years from 1988 to 2007 in Olmsted County, Minnesota, and their age-matched (±1 year) referent women who did not undergo bilateral oophorectomy. Main outcome measures: The medical records of all women were reviewed to collect the metabolic parameters over a 10-year period. We compared three groups of women: 1) referent women (n = 270), 2) women who underwent bilateral oophorectomy and received estrogen therapy (n = 163), and 3) women who underwent bilateral oophorectomy and did not receive estrogen therapy (n = 107). Results: Over 10 years of follow-up, the three groups had significantly different mean values of diastolic blood pressure, weight, body mass index (BMI), total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-C). However, women with and without bilateral oophorectomy were already different at baseline for hyperlipidemia, systolic blood pressure, weight, and BMI. Nevertheless, the trajectories of change over 10 years were significant for weight (group by time interaction p = 0.03), BMI (p = 0.03), and HDL-C (p = 0.004). The changes occurred primarily in the initial 4-5 years. Women who received estrogen therapy after bilateral oophorectomy were comparable to the referent women with respect to the weight and BMI trends, and they experienced an increase in HDL-C over time. Conclusion: Women who underwent bilateral oophorectomy before menopause experienced unfavorable changes in some metabolic parameters possibly increasing their cardiovascular risk.
MeSH term(s)	Age Factors ; Cholesterol ; Cohort Studies ; Estrogens/therapeutic use ; Female ; Humans ; Lipoproteins, HDL ; Ovariectomy/adverse effects ; Risk Factors ; Triglycerides
Chemical Substances	Estrogens ; Lipoproteins, HDL ; Triglycerides ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2022-07-21
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	80460-5
ISSN	1873-4111 ; 0378-5122
ISSN (online)	1873-4111
ISSN	0378-5122
DOI	10.1016/j.maturitas.2022.07.005
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Article ; Online: Time Trends in Unilateral and Bilateral Oophorectomy in a Geographically Defined American Population.

Erickson, Zachary / Rocca, Walter A / Smith, Carin Y / Gazzuola Rocca, Liliana / Stewart, Elizabeth A / Laughlin-Tommaso, Shannon K / Mielke, Michelle M

Obstetrics and gynecology

2022 Volume 139, Issue 5, Page(s) 724–734

Abstract: Objective: To evaluate trends in the incidence of premenopausal unilateral and bilateral oophorectomy between 1950 and 2018.: Methods: The Rochester Epidemiology Project medical records-linkage system was used to identify all women aged 18-49 years ... ...

Abstract	Objective: To evaluate trends in the incidence of premenopausal unilateral and bilateral oophorectomy between 1950 and 2018. Methods: The Rochester Epidemiology Project medical records-linkage system was used to identify all women aged 18-49 years who were residents of Olmsted County, Minnesota, and underwent unilateral or bilateral oophorectomy before spontaneous menopause between January 1, 1950, and December 31, 2018. Population denominators were derived from the U.S. Decennial Censuses for the years 1950-2010, and intercensal year population denominators were linearly interpolated. For 2011-2018, the annual population denominators were obtained from the U.S. Census projections. Where appropriate, overall incidence rates were age-adjusted to the total U.S. female population from the 2010 Census. Results: There were 5,154 oophorectomies in Olmsted County across the 69-year period between 1950 and 2018, and 2.9% showed malignant disease on pathology. A total of 2,092 (40.6%) women underwent unilateral oophorectomy, and 3,062 (59.4%) women underwent bilateral oophorectomy. More than half (n=1,750, 57.2%) of the bilateral oophorectomies occurred between 1990 and 2009. Until 1975-1979, the incidence of unilateral oophorectomy was mostly higher than bilateral oophorectomy. From 1980-1984 until 2000-2004, the incidence of bilateral oophorectomy more than doubled and the incidence of unilateral oophorectomy declined. After 2005, both procedures declined and converged to a similar incidence in 2015-2018. The decline in premenopausal bilateral oophorectomy over the past 14 years (2005-2018) was most pronounced for women who underwent oophorectomy concurrently with hysterectomy or did not have any ovarian indication. Conclusion: The incidence rates of unilateral and bilateral oophorectomy have varied greatly across the 69-year period of this study. In the past 14 years, the incidence of premenopausal unilateral and bilateral oophorectomy has decreased. These trends reflect the effects of the initial 2005-2006 publications and the subsequent expanding body of evidence against the practice of oophorectomy for noncancer indications.
MeSH term(s)	Female ; Humans ; Hysterectomy ; Incidence ; Male ; Ovariectomy ; Ovary ; Premenopause
Language	English
Publishing date	2022-04-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000004728
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Article ; Online: Adverse childhood experiences and adult abuse are predictors of hysterectomy and oophorectomy.

Gazzuola Rocca, Liliana / Smith, Carin Y / Stewart, Elizabeth A / Rocca, Walter A

Maturitas

2017 Volume 106, Page(s) 95–96

Language	English
Publishing date	2017-12
Publishing country	Ireland
Document type	Editorial
ZDB-ID	80460-5
ISSN	1873-4111 ; 0378-5122
ISSN (online)	1873-4111
ISSN	0378-5122
DOI	10.1016/j.maturitas.2017.08.001
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Article ; Online: Identifying Information Gaps in Electronic Health Records by Using Natural Language Processing: Gynecologic Surgery History Identification.

Moon, Sungrim / Carlson, Luke A / Moser, Ethan D / Agnikula Kshatriya, Bhavani Singh / Smith, Carin Y / Rocca, Walter A / Gazzuola Rocca, Liliana / Bielinski, Suzette J / Liu, Hongfang / Larson, Nicholas B

Journal of medical Internet research

2022 Volume 24, Issue 1, Page(s) e29015

Abstract: Background: Electronic health records (EHRs) are a rich source of longitudinal patient data. However, missing information due to clinical care that predated the implementation of EHR system(s) or care that occurred at different medical institutions ... ...

Abstract	Background: Electronic health records (EHRs) are a rich source of longitudinal patient data. However, missing information due to clinical care that predated the implementation of EHR system(s) or care that occurred at different medical institutions impedes complete ascertainment of a patient's medical history. Objective: This study aimed to investigate information discrepancies and to quantify information gaps by comparing the gynecological surgical history extracted from an EHR of a single institution by using natural language processing (NLP) techniques with the manually curated surgical history information through chart review of records from multiple independent regional health care institutions. Methods: To facilitate high-throughput evaluation, we developed a rule-based NLP algorithm to detect gynecological surgery history from the unstructured narrative of the Mayo Clinic EHR. These results were compared to a gold standard cohort of 3870 women with gynecological surgery status adjudicated using the Rochester Epidemiology Project medical records-linkage system. We quantified and characterized the information gaps observed that led to misclassification of the surgical status. Results: The NLP algorithm achieved precision of 0.85, recall of 0.82, and F1-score of 0.83 in the test set (n=265) relative to outcomes abstracted from the Mayo EHR. This performance attenuated when directly compared to the gold standard (precision 0.79, recall 0.76, and F1-score 0.76), with the majority of misclassifications being false negatives in nature. We then applied the algorithm to the remaining patients (n=3340) and identified 2 types of information gaps through error analysis. First, 6% (199/3340) of women in this study had no recorded surgery information or partial information in the EHR. Second, 4.3% (144/3340) of women had inconsistent or inaccurate information within the clinical narrative owing to misinterpreted information, erroneous "copy and paste," or incorrect information provided by patients. Additionally, the NLP algorithm misclassified the surgery status of 3.6% (121/3340) of women. Conclusions: Although NLP techniques were able to adequately recreate the gynecologic surgical status from the clinical narrative, missing or inaccurately reported and recorded information resulted in much of the misclassification observed. Therefore, alternative approaches to collect or curate surgical history are needed.
MeSH term(s)	Algorithms ; Cohort Studies ; Electronic Health Records ; Female ; Gynecologic Surgical Procedures ; Humans ; Natural Language Processing
Language	English
Publishing date	2022-01-28
Publishing country	Canada
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/29015
Database	MEDical Literature Analysis and Retrieval System OnLINE

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