Variability in surgical management of benign ovarian neoplasms in children

• Published in: Journal of pediatric surgery 2017-06, Vol.52 (6), p.944-950
• Main Authors: Gonzalez, Dani O, Cooper, Jennifer N, Aldrink, Jennifer H, Hewitt, Geri D, Fallat, Mary E, Minneci, Peter C, Deans, Katherine J
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Female; Healthcare Disparities - statistics & numerical data; Hospitals, Pediatric - statistics & numerical data; Humans; Logistic Models; Oophorectomy; Organ Sparing Treatments - statistics & numerical data; Organ Sparing Treatments - utilization; Ovarian neoplasm; Ovarian Neoplasms - surgery; Ovariectomy - statistics & numerical data; Ovariectomy - utilization; Ovary; Ovary-sparing; Pediatric; Pediatrics; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Surgery; Tertiary Care Centers - statistics & numerical data; United States; Young Adult
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2017.03.014

Abstract Background/Purpose Although most pediatric ovarian neoplasms are benign and may be treated with ovary-sparing surgery (OSS), consensus is lacking on the optimal surgical approach. We aimed to determine the proportion of pediatric benign ovarian neoplasms managed with OSS and to assess variability in management across hospitals and specialties. Methods Using the Pediatric Health Information System, we studied patients aged 6-21 years treated in 2006-2014 for a benign ovarian neoplasm with oophorectomy or OSS. Interhospital variability and predictors of the type of surgery were determined using logistic mixed effects models with random hospital effects. Results Of 1164 patients with benign ovarian neoplasms, 646 underwent oophorectomy, and 518 underwent OSS. Across hospitals, there was significant variability in the proportion of OSS (range: 21.7-76.6%). In multivariable analysis, patients managed by pediatric surgeons (vs. pediatric and adolescent gynecologists) (OR:0.27, 95%CI:0.17-0.43, p < 0.001), younger patients (OR:0.94 per year, 95%CI:0.90-0.98, p = 0.007), and those admitted through the emergency department (OR:0.76, 95%CI:0.58-0.99, p = 0.04) were less likely to undergo OSS. Interhospital variability remained significant after adjusting for relevant patient and hospital characteristics (p < 0.001). Conclusions Significant variability exists in management of benign ovarian neoplasms across hospitals and specialties. Collaborative efforts between treating specialists may improve implementation of evidence-based guidelines for OSS. Type of study: retrospective study Level of evidence: III