title: Rate of Oophorectomy for Benign Indications in a Children's Hospital: Influence of a Gynecologist.
abstract: OBJECTIVE
  To compare the rates of oophorectomy performed by pediatric surgeons for benign indications before and after the addition of a gynecologist to the surgical staff of a children's hospital. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We used a retrospective chart review of patients ages 5-21 years who underwent surgical management by pediatric surgeons for benign adnexal indications at a tertiary care children's hospital. Patient characteristics and clinical outcomes were recorded. Rates of oophorectomy for patients managed before the addition of a gynecologist (1998-2004) were compared with those managed after a gynecologist joined the surgical staff (2005-2013). Logistic regression analysis was conducted to compare the likelihood of oophorectomy before and after the addition of a gynecologist to the surgical staff.
  
  
  RESULTS
  One hundred sixty-five cases were included in the final analysis. Pediatric surgeons were 8 times more likely to perform an oophorectomy for benign indications before the addition of a gynecologist to the surgical staff (odds ratio, 8.3; 95% confidence interval, 3.76-18.16). Oophorectomy was performed in 45% (25/56) of cases from 1998 to 2004 compared with 11% (12/109) of cases from 2005 to 2013. Younger age (P = .009), ischemic-appearing adnexa (P < .0001), presence of torsion (P = .017), and mature teratoma (P = .041) were associated with higher likelihood of oophorectomy.
  
  
  CONCLUSIONS
  There was a higher rate of ovarian preservation for benign indications performed by pediatric surgeons after the addition of a gynecologist to the surgical staff. Younger patients, those with a mature teratoma, and ovarian torsion continue to be at higher risk for oophorectomy.
authors: Children's National Health Services, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: Gylynthia@gmail.com.
authors: Gylynthia E
authors: GE
authors: Trotman
authors: Georgetown University School of Medicine, Washington, District of Columbia.
authors: Helen
authors: H
authors: Cheung
authors: MedStar Health Research Institute, Hyattsville, Maryland.
authors: Eshetu A
authors: EA
authors: Tefera
authors: MedStar Washington Hospital Center, Washington, District of Columbia.
authors: Renuka
authors: R
authors: Darolia
authors: Children's National Health Services, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia; Georgetown University School of Medicine, Washington, District of Columbia.
authors: Veronica
authors: V
authors: Gomez-Lobo
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003884:Dermoid Cyst / Q000601:surgery; D005260:Female; D006176:Gynecology / Q000379:methods / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D010049:Ovarian Diseases / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D010053:Ovary / Q000002:abnormalities / Q000601:surgery; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Benign adnexal pathology; Oophorectomy; Ovarian preservation; Ovarian torsion