Variation in Oophorectomy Rates for Children with Ovarian Torsion across US Children's Hospitals

Lipsett, Susan C.; Haines, Lalita; Monuteaux, Michael C.; Hayes, Katherine; Michelson, Kenneth A.

doi:10.1016/j.jpeds.2020.12.019

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…Similarly, another study from USA in 2020 reported oophorectomy rate as 22.5%. Recently, it has been argued that the rate of oophorectomy has been decreasing in cases with torsion, but this is still not sufficient (17). In our clinic, the rate of oophorectomy in cases with torsion is at an acceptable level with 40.6%, according to these studies.…”

Section: Discussionmentioning

confidence: 67%

“…These show that worrying for malignancy is unfounded. Lately, it has been recommended that the mass or malignancy should be evaluated with postoperative USG after detorsion if it is not possible to dissect the ovarian tissue from the mass during surgery in cases with a mass and torsioned ovary (16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of torsioned ovary has changed over time from oophorectomy to ovary sparing surgery. Today, oophorectomy is not recommended even if the ovary is necrotic (16,17). A study conducted in the USA in 2015 reported oophorrectomy rate as 78% on 2041 pediatric ovarian torsion cases (16).…”

Section: Discussionmentioning

confidence: 99%

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Surgical Ovary Masses in Children: A Single Center Experience of 11 Years

Yıldız¹,

Arpacik²,

SİRİN³

et al. 2022

Turkish Journal of Pediatric Disease

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Objective: The majority of childhood ovarian masses are benign. However, malignant tumors encountered in adulthood may also be seen in childhood. There is still no ovarian tumor management protocol for children. We shared our experiences with ovarian mass cases operated in our clinic.Material and Methods: Patients aged 0-18 years and had surgery in our hospital between 2010 and 2020 due to ovarian masses were included in the study. The ages of the patients, the maximum diameter and structure of the mass on ultrasonography (USG) and other imaging modalities, symptoms on presentation, tumor markers, operation data, and histopathology results were recorded. The patients were divided into three groups in relation with tumor histopathology, and the demographic data were compared among groups. Results:In 11-year period, 107 surgical operations were performed on 106 patients due to ovarian masses. The ages of the patients were between 2 days and 17 years, with a mean age of 13.4±14.1 years. Of the masses, 9 (8.4%) were malignant (3 (2.8%) borderline), 44 (41.1%) were benign, and 54 (50.5) were non-neoplastic. Histopathology results of 53 surgical operations performed for neoplastic ovarian masses were germ cell tumor in 31 (29%), epithelial tumor in 19 (17.8%), sex cord stromal tumor in 2 (1.9%), and leiomyoma 1 (0.9%) patient. Conclusion:Adult protocols should be used when necessary in rare childhood ovarian malignant tumors, and large multicenter patient series should be constituted in order to establish pediatric protocols related to the subject. A multidisciplinary approach is necessary in childhood ovarian masses.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical Ovary Masses in Children: A Single Center Experience of 11 Years

Yıldız¹,

Arpacik²,

SİRİN³

et al. 2022

Turkish Journal of Pediatric Disease

View full text Add to dashboard Cite

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“…The ovary’s vascular supply becomes impaired over time, resulting in ovarian infarction or other morbidities, including peritonitis, hemorrhage, sepsis, or adhesion [ 4 , 5 ]. Potential reasons for oophorectomy include suspicion of underlying malignancy or ischemic ovary [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A lack of Doppler US signals is associated with torsion, but this finding lacks reliability since the literature indicates that 20–73% of torted ovaries lack Doppler flow [ 13 ]. In a multicenter study, the rates of oophorectomy for children with ovarian torsion in U.S. children’s hospitals were up to 22.5% [ 6 ]. Most investigations indicated that the low salvage rate was related to diagnostic and surgical delays caused by the nonspecific ovarian torsion symptom [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Risk Factors for Ischemic Ovary Torsion in Children

et al. 2022

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Identifying ischemic ovary as a complication of ovary torsion (OT) is a significant challenge in children. This study identified risk factors for ischemic OT among pediatric OT patients to prevent delayed treatment. This retrospective study included pediatric inpatients who underwent operation for OT over 20 years. We employed multivariable logistic regression to find the risk factors associated with ischemic OT. Among the 118 patients included in this study, 78 (66.1%) had ischemic OT. Patients with ischemic OT tended to be younger; had more frequent vomiting; and had elevated White blood cell (WBC), C-Reactive protein (CRP), and segments in comparison with non-ischemic OT patients. Multivariable regression showed increased odds of ischemic ovary torsion, associated with higher WBC (12.3 × 103/mm3 vs. 8.7 × 103/mm3, p < 0.001), CRP (50.4 mg/L vs. 8.4 mg/L, p < 0.001), and vomiting (55.1% vs. 25%, p = 0.002) than in non-ischemic patients. A receiver-operating characteristic (ROC) analysis indicated that patients with vomiting, leukocytosis, or CRP ≧ 40 mg/L were more likely to have ischemic OT (sensitivity, 92%; specificity, 54%; PPV, 79.6; NPV, 78.9%). Ischemic OT is common among pediatric OT patients. The presence of potential risk factors of vomiting, leukocytosis, and CRP more significant than 40 mg/L may assist clinicians in ensuring an expedited surgical treatment.

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Rate of oophorectomy in pediatric ovarian torsion: risk factors and change over time

Ayemoba,

Callier,

Johnson

2024

Pediatr Surg Int

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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.

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Variation in Oophorectomy Rates for Children with Ovarian Torsion across US Children's Hospitals

Cited by 10 publications

References 11 publications

Surgical Ovary Masses in Children: A Single Center Experience of 11 Years

Surgical Ovary Masses in Children: A Single Center Experience of 11 Years

Characteristics and Risk Factors for Ischemic Ovary Torsion in Children

Rate of oophorectomy in pediatric ovarian torsion: risk factors and change over time

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