Ovarian Torsion: Time Limiting Factors for Ovarian Salvage

Abstract

Aim: Analysis of the timelines in the diagnosis and management of surgically treated ovarian torsion will provide novel information on significant time intervals that may be amenable to future improvement which will optimize ovarian salvage rates. Methods: A retrospective review was performed of all patients who had surgically confirmed adnexal torsion over 12 years. The following four times were extracted for each patient (1) Emergency Department (ED) Triage (2) ED physician assessment (3) Generation of ultrasound report (4) Operating room (OR) start time. Overall time from ED triage to surgery and ovarian salvage rates were also documented. Results: Of 86 surgically proven ovarian torsion cases, 63 (73%) had documentation of all timelines and were included in the study. The overall median time from ED triage to surgery was 14.8 hours. Individual median times were as follows: from ED triage to ED physician assessment 1.3 hours; ED physician assessment to ultrasound imaging report provision 3 hours and imaging report provision to surgical intervention 6.8 hours. Overall ovarian salvage with detorsion occurred in 34 (54%) of cases. Lengthier time delays to surgery were associated with lower ovarian salvage rates. Conclusion: This study is the first to quantify the time contribution of four major steps in a patient's journey from ED triage to surgical intervention thus providing an opportunity to identify potential targets for quality improvements and serve as a baseline for measuring future improvements. The study confirms that lengthier time delays to surgery are associated with lower ovarian salvage rates.