8744 Factors Associated with Oophorectomy Among Pediatric Ovarian Torsion Patients

Abstract

<h3>Study Objective</h3> Ovarian torsion (OT) is the fifth most common gynecologic emergency, with one-third of cases occurring in females younger than 20 years-old. We aimed to evaluate factors associated with oophorectomy at the time of surgery for suspected OT in our pediatric population. <h3>Design</h3> Retrospective cohort analysis. <h3>Setting</h3> Tertiary, academic medical center. <h3>Patients or Participants</h3> Patients less than 18 years of age undergoing surgery for suspected ovarian torsion between 2016-2021. <h3>Interventions</h3> Evaluation of patient demographics, presentation timeline, imaging characteristics, and surgical variables associated with oophorectomy as well as perioperative outcomes. <h3>Measurements and Main Results</h3> Forty-five pediatric patients underwent surgical management for suspected ovarian torsion. Five patients were excluded for planned management of antenatally diagnosed ovarian masses, of which 3 underwent oophorectomy. Of the 40 included patients, 26 (65%) were confirmed to be torsed intra-operatively. Seventeen of these patients (66%) underwent ovarian preserving surgery (OPS) while 9 (34%) underwent unilateral oophorectomy (UO). Between the UO and OPS group, there were no differences in age or race. There were no differences in ultrasound findings including absent flow, enlarged ovary, and peripheral follicles; however, the UO group had significantly larger associated ovarian masses (12.48cm vs 8.06cm, p = .015). The median time from presentation to surgical start was 480 minutes (IQR 336-800.75) in the OPS group versus 868 minutes (IQR 257.5-1353.5) in the UO group. There was no association with primary surgical service (Pediatric Surgery versus Gynecology) however time from presentation to OR was significantly faster amongst patients treated by gynecologists (p=0.018). 50% of oophorectomy patients had a minimally invasive approach compared to 78.6% in the OPS group; however, this varied significantly by surgical specialty. <h3>Conclusion</h3> Given the significant sequelae associated with oophorectomy, current standards in surgical management of OT recommend conservative, ovarian-preserving techniques. Our data supports that delayed time to surgery and larger adnexal masses are associated with oophorectomy at the time of surgical management.