Introduction We evaluated real-world outcomes in patients with advanced ovarian cancer (AOC) based on their cumulative risk profile and maintenance therapy (MT) status following first-line (1L) treatment. Methods This retrospective observational study of a nationwide electronic health record-derived de-identified database included adult patients diagnosed with stage III/IV OC from January 1, 2011 to February 28, 2021, who received 1L therapy and had ≥ 12 weeks of follow-up after the index date (end of 1L therapy). Patients were grouped according to whether they received MT or active surveillance (AS) following 1L treatment and by the cumulative number of risk factors (RF) present (stage IV disease; no surgery/treated with neoadjuvant therapy and interval debulking surgery; had postoperative visible residual disease; and had BRCA wild-type disease/unknown BRCA status). Time to next treatment (TTNT) and overall survival (OS) were assessed with a cloning and inverse probability of censoring (IPC)-weighted Kaplan–Meier method. Results Among 1920 patients, 22.2% received MT and 77.8% received AS. Median IPC-weighted TTNT and OS were 13.3 months (95% CI 11.7–15.8) and 39.1 months (95% CI 32.5–48.6) in the MT cohort, respectively, and 8.6 months (95% CI 8.0–9.5) and 38.4 months (95% CI 36.4–41.0) in the AS cohort, respectively. Almost all patients had ≥ 1 RF (MT 95.3%; AS 96.7%). Median IPC-weighted TTNT was shorter among patients with more RF in both cohorts (MT: 1 RF, 19.3 months, 95% CI 13.5–37.8; 2 RF, 17.2 months, 95% CI 12.8–20.2; 3 RF, 11.0 months, 95% CI 8.2–13.8; 4 RF, 7.0 months, 95% CI 6.2–8.8; AS: 1 RF, 17.7 months, 95% CI 13.5–22.3; 2 RF, 10.2 months, 95% CI 9.1–11.5; 3 RF, 6.5 months, 95% CI 5.8–7.4; 4 RF, 4.1 months, 95% CI 3.5–4.5). Conclusion Regardless of RF number, MT was associated with longer TTNT in real-world patients with AOC.