Rate of oophorectomy in pediatric ovarian torsion: risk factors and change over time
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In brief
In brief
This retrospective study of 7,008 pediatric ovarian torsion cases shows oophorectomy rates have declined over time, though disparities persist. Patients with benign neoplasms and those treated at rural hospitals remain at higher risk for oophorectomy despite current recommendations favoring ovarian salvage.
- Oophorectomy rates in pediatric ovarian torsion have decreased over time, reflecting improved adoption of ovarian-salvage techniques.
- Patients with benign ovarian neoplasms remain at 2× higher risk for oophorectomy despite low malignancy rates (0.4% in this cohort).
- Rural hospitals perform oophorectomy more frequently than urban teaching centers, suggesting geographic disparities in surgical approach.
- Ovarian salvage is now standard of care given fertility preservation goals and rarity of malignancy in pediatric ovarian torsion.
- Continued education is needed to reduce unnecessary oophorectomy, especially for benign neoplasms and in non-academic settings.
Written by the GCMD Library team from the article.
Abstract
Purpose
The management of ovarian torsion in pediatric patients has evolved over time. Ovarian salvage is currently recommended given concerns for fertility preservation and the low likelihood of malignancy. Studies have shown that the incidence of oophorectomy is higher amongst pediatric surgeons in comparison to gynecologists. Using a national database, this study examined how the surgical management of ovarian torsion has evolved.
Methods
Children with a discharge diagnosis of ovarian torsion (ICD-9 code 620.5, ICD-10 code N835X) and procedure codes for oophorectomy (CCS code 119) were identified within the KID database from 2003, 2006, 2009, 2012, 2016, and 2019. Diagnosis of ovarian pathology was based upon ICD-9 and ICD-10 codes at the time of discharge.
Results
A total of 7008 patients, ages 1–20, had a discharge diagnosis of ovarian torsion. Of those patients, 2,597 (37.1%) were diagnosed with an ovarian cyst, 1560 (22.2%) were diagnosed with a benign ovarian neoplasm, and 30 (0.4%) were diagnosed with a malignant neoplasm. There was a decreased risk of oophorectomy in urban-teaching versus rural hospitals (OR: 0.64, p < 0.001). The rate of oophorectomy has decreased overtime. However, patients with benign or malignant neoplasms were more likely to undergo oophorectomy than those without a diagnosis (OR: 2.03, p < 0.001; 4.82, p < 0.001).
Conclusion
The rate of oophorectomy amongst children with ovarian torsion has decreased over time. Yet, despite improvements, oophorectomy is common amongst patients with benign ovarian neoplasms and those treated at rural hospitals. Continued education is needed to optimize patient care in all clinical scenarios.
Level of evidence
IV.