Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway
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In brief
In brief
Retrospective study of 86 adolescents with adnexal torsion managed by pediatric surgeons or gynecologists shows similar surgical outcomes and fertility preservation rates between specialties, though gynecology patients had shorter hospital stays. Findings support development of a unified multidisciplinary care pathway to streamline evaluation and reduce delays in this time-sensitive gynecologic emergency.
Written by the GCMD Library team from the article.
Abstract
Purpose
Adnexal torsion is a gynecologic emergency, requiring intervention for tissue preservation. At our institution, torsion is managed by pediatric surgeons or gynecologists. We evaluated differences between specialties to streamline evaluation for children with gynecological emergencies, develop a clinical pathway, and prevent care delays.
Methods
A retrospective review of adolescents undergoing intervention for adnexal torsion from 2004–2018 was performed. Differences in time to intervention, operation duration, the procedure performed, and length of stay (LOS) between the specialties were analyzed.
Results
Eighty-six patients underwent 94 operations for presumed adnexal torsion with 87 positive cases. Pediatric surgeons performed 60 operations and 34 cases were performed by gynecologists. Preservation of fertility was the goal in both cohorts and the rate of oophoropexy, cystectomy, and oophorectomy were similar between the cohorts (p = 0.14, p = 1.0, p = 0.39, respectively). There was no difference in intra-operative time (p = 0.69). LOS was shorter in the gynecology cohort (median 1 day [1–2] vs. 2 days [2–3], p > 0.001).
Conclusions
Adnexal torsion is a time-sensitive diagnosis requiring prompt intervention for ovarian or fallopian tube preservation. A multidisciplinary institutional care pathway should be developed and implemented.