SUSTAINED POSITIVE PRACTICE CHANGE AFTER TARGETED EDUCATION IN THE MANAGEMENT OF OVARIAN TORSION

Abstract

BackgroundFailure to perform ovarian conservation surgery (OCS) for patients who present with adnexal torsion was recognized as a practice gap by the American Pediatric Surgical Association (APSA) in 2017. A targeted educational campaign was conducted to promote detorsion and ovarian conservation surgery as the standard of care for ovarian torsion. We evaluated the practice change that has occurred for pediatric and adolescent patients with ovarian torsion from 2012-2022. MethodsUsing the American College of Surgeons (ACS) National Safety and Quality Improvement Project-Pediatrics (NSQIP-P) Participant Use Files from 2012-2022, we compared surgical treatment types during the time periods that encompassed the targeted educational period. ResultsA total of 2,249 patients (70%) underwent OCS surgery and 980 (30%) patients underwent salpingectomy and/or oophorectomy (SO). Patients who were treated with OCS were older (12.4 [SD 3.6] vs. 11.4 [SD 4.8] years, p < 0.01). Patients were more likely to be treated with SO if they were Black (11 vs. 15%, p<0.01) or obese (28 vs. 33%, p<0.01). From 2012-2017, 42% of patients underwent OCS, compared to 76% in 2018-2022 (p <0.01). A mixed effect analysis comparing year-over-year rates of SO across pediatric surgeons and gynecologic surgeons showed a statistically significant difference in rates across specialty and time (p<0.01), with pediatric surgeons performing fewer SOs. ConclusionIn the treatment of ovarian torsion in pediatric and adolescent patients, we demonstrated successful adoption and sustained implementation of practice improvement coincident with the introduction of a comprehensive educational initiative. TYPE OF STUDYRetrospective cohort LEVEL OF EVIDENCEIV