Background: Failure 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 to 2022.
Methods: Using the American College of Surgeons (ACS) National Safety and Quality Improvement Project-Pediatrics (NSQIP-P) Participant Use Files from 2012 to 2022, we compared surgical treatment types during the time periods that encompassed the targeted educational period.
Results: A total of 2249 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 to 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.
Conclusion: In 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 Study: Retrospective cohort.
Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.jpedsurg.2024.162062 | DOI Listing |
Am Fam Physician
December 2024
Indiana University School of Medicine, Indianapolis.
Acute abdominal pain in children is a common presentation in the clinic and emergency department settings and accounts for up to 10% of childhood emergency department visits. Determining the appropriate disposition of abdominal pain in children can be challenging. The differential diagnosis of acute abdominal pain, including gastroenteritis, constipation, urinary tract infection, acute appendicitis, tubo-ovarian abscess, testicular torsion, and volvulus, and the diagnostic approach vary by age.
View Article and Find Full Text PDFJ Minim Invasive Gynecol
December 2024
Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China. Electronic address:
SAGE Open Med Case Rep
December 2024
Department of Pathology, School of Medicine, Wollega University, Nekemte City, Oromia Regional State, Ethiopia.
Uterine fibroids are benign tumors, arising from uterine smooth muscle cells. They are one of the most common benign tumors of the female genital tract among childbearing women, occurring in 20%-50% of women of reproductive age. The association of uterine myomas with pregnancy is high.
View Article and Find Full Text PDFJ Clin Med
December 2024
Faculty of Medicine, University of Niš, Blvd. Dr Zorana Đinđića 81, 18000 Niš, Serbia.
Uterine torsion represents a rare condition that may occur during pregnancy or in non-gravid women. This condition is difficult to diagnose, since there are no specific signs besides abdominal pain. Thus, most of the cases are not diagnosed correctly before a surgical procedure and may result in complications and poor outcomes.
View Article and Find Full Text PDFDiagnostics (Basel)
December 2024
Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 13, 40138 Bologna, Italy.
The aim of this study was to evaluate prenatal ultrasound features, fetal postnatal outcomes, and the need for postnatal surgery in the suspicion of ovarian torsion. We included patients with a singleton pregnancy with a suspicion of ovarian fetal cyst referred to our center. Data derived from prenatal ultrasound evaluations, delivery, and postnatal follow-up were then extracted from the hospital registers.
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