title: Current trends in the surgical treatment of pediatric ovarian torsion: we can do better.
abstract: BACKGROUND
  Current literature strongly recommends ovarian preservation for pediatric patients with ovarian torsion. The purpose of this study was to evaluate national trends in the surgical management of pediatric ovarian torsion and to compare outcomes between pediatric surgeons (PED) and gynecologists (GYN).
  
  
  METHODS
  We queried Pediatric Health Information System (PHIS) data from 2007 to 2011 for patients <18years old with a diagnosis of ovarian torsion who underwent a surgical procedure. Patients with malignant disease were excluded. Outcomes were compared between pediatric surgeons and gynecologists.
  
  
  RESULTS
  A total of 1151 patients were identified with a mean age of 10.7±4.1years with a bimodal distribution. Pediatric surgeons performed the majority of procedures (81%) and were more likely to use a laparoscopic approach (PED 27% vs. GYN 17%, p<.05). Pediatric surgeons were more likely to perform an oophorectomy (PED 38% vs. GYN 27%, p<.01), and more likely to administer antibiotics for this clean procedure (PED 61% vs. GYN 29%, p<.001). The overall reoperation rate was 5.1% and did not differ significantly by subspecialty (PED 4.4% vs. GYN 7.8%, p>.05).
  
  
  CONCLUSIONS
  These data demonstrate a significant opportunity for pediatric surgeons and gynecologists to improve ovarian salvage rates and to reduce unnecessary antibiotic utilization for children with ovarian torsion.
authors.affiliation: Department of Pediatric Surgery, Connecticut Children's Medical Center and the University of Connecticut School of Medicine, Hartford, CT, USA. Electronic address: bcampbell@connecticutchildrens.org.
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Campbell
authors.affiliation: Department of Pediatric Surgery, Connecticut Children's Medical Center and the University of Connecticut School of Medicine, Hartford, CT, USA.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Austin
authors.affiliation: Department of Pediatric Surgery, Connecticut Children's Medical Center and the University of Connecticut School of Medicine, Hartford, CT, USA.
authors.forename: Owen
authors.initials: O
authors.lastname: Kahn
authors.affiliation: Department of Pediatric Surgery, Connecticut Children's Medical Center and the University of Connecticut School of Medicine, Hartford, CT, USA.
authors.forename: Melissa C
authors.initials: MC
authors.lastname: McCann
authors.affiliation: Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Trudy J
authors.initials: TJ
authors.lastname: Lerer
authors.affiliation: Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Shefali
authors.initials: S
authors.lastname: Thaker
authors.affiliation: Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Herbst
authors.affiliation: Department of Pediatric Surgery, Connecticut Children's Medical Center and the University of Connecticut School of Medicine, Hartford, CT, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Rader
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D006176:Gynecology / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends; D010049:Ovarian Diseases / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data / Q000639:trends; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D014102:Torsion Abnormality / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data / Q000639:trends
keywords: Gynecology; Ovarian torsion; Pediatrics; Subspecialization; Surgery