Surgical Practice Patterns in the Management of Ovarian Torsion

Abstract

<h3>Study Objective</h3> Ovarian torsion (OT) is a common gynecologic emergency with the potential for significant lifelong health and fertility sequelae. We aimed to evaluate surgical practice patterns in the management of patients with concern for OT, in particular factors associated with oophorectomy versus ovarian preserving surgery (OPS) and rates of minimally invasive surgery (MIS). <h3>Design</h3> Retrospective cohort analysis <h3>Setting</h3> Tertiary medical center <h3>Patients or Participants</h3> All patients presenting acutely with symptoms concerning for OT who underwent surgical management between 2016-2021. Patients with incidental torsion at the time of scheduled surgery were excluded from this analysis. <h3>Interventions</h3> Evaluation of patient demographics, background clinical context, imaging findings, and surgical variables including primary specialty, surgical approach, procedures performed, and perioperative outcomes. <h3>Measurements and Main Results</h3> One hundred twenty-six-patient underwent 129 surgeries for suspected ovarian torsion. Of this, 75 cases (59.52%) were confirmed to be torsed. In total, 73 (57.9%) patients underwent OPS while 52 (41.3%) underwent oophorectomy. Patients who underwent OPS compared to oophorectomy were noted to be significantly younger (mean age 23.3 vs 29.3, p = 0.012) and have a lower BMI (mean 25.0 vs 29.7, p = 0.011). The proportion of OPS cases varied significantly by subspecialty with OPS performed in 56.9% of cases performed by Obstetrics and Gynecology generalists, 67.7% of cases by minimally invasive gynecologic surgeons (MIGS), 6% of cases by gynecologic oncologists (GO), and 79% of cases by pediatric surgeons. This data is confounded by patient age, fertility goals, and concern for malignancy. 90.28% of OPS cases were performed via a MIS approach while 69.2% of oophorectomies were MIS. MIS rates varied significantly by surgical subspecialty: 88% among generalists, 96.7% among MIGS, 60% among gynecologic oncologists, and 60% among pediatric surgeons. <h3>Conclusion</h3> The surgical management of OT varies widely. Our data supports that age, BMI, and surgical subspecialty influence surgical approach and management.