Variations in the management of adolescent adnexal torsion at a single institution and the creation of a unified care pathway.

Abstract:

PURPOSE:Adnexal torsion is a gynecologic emergency, requiring intervention for tissue preservation. At our institution, torsion is managed by pediatric surgeons or gynecologists. We evaluated differences between specialties to streamline evaluation for children with gynecological emergencies, develop a clinical pathway, and prevent care delays. METHODS:A retrospective review of adolescents undergoing intervention for adnexal torsion from 2004-2018 was performed. Differences in time to intervention, operation duration, the procedure performed, and length of stay (LOS) between the specialties were analyzed. RESULTS:Eighty-six patients underwent 94 operations for presumed adnexal torsion with 87 positive cases. Pediatric surgeons performed 60 operations and 34 cases were performed by gynecologists. Preservation of fertility was the goal in both cohorts and the rate of oophoropexy, cystectomy, and oophorectomy were similar between the cohorts (p = 0.14, p = 1.0, p = 0.39, respectively). There was no difference in intra-operative time (p = 0.69). LOS was shorter in the gynecology cohort (median 1 day [1-2] vs. 2 days [2-3], p > 0.001). CONCLUSIONS:Adnexal torsion is a time-sensitive diagnosis requiring prompt intervention for ovarian or fallopian tube preservation. A multidisciplinary institutional care pathway should be developed and implemented.

journal_name

Pediatr Surg Int

authors

Alberto EC,Tashiro J,Zheng Y,Sandler A,Kane T,Gomez-Lobo V,Petrosyan M

doi

10.1007/s00383-020-04782-1

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

129-135

issue

1

eissn

0179-0358

issn

1437-9813

pii

10.1007/s00383-020-04782-1

journal_volume

37

pub_type

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