Variability in surgical management of benign ovarian neoplasms in children.
OBJECTIVE
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. Inter-hospital 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. Inter-hospital 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.


METHODS
retrospective study LEVEL OF EVIDENCE: III.
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Dani O
DO
Gonzalez
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Jennifer N
JN
Cooper
Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Jennifer H
JH
Aldrink
Department of Surgery, Division of Obstetrics and Gynecology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Geri D
GD
Hewitt
Department of Surgery, Division of Pediatric Surgery, University of Louisville, Kosair Children's Hospital, Louisville, KY.
Mary E
ME
Fallat
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
Peter C
PC
Minneci
Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. Electronic address: Katherine.Deans@nationwidechildrens.org.
Katherine J
KJ
Deans
D000293:Adolescent; D002648:Child; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D010051:Ovarian Neoplasms / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
Adolescent; Oophorectomy; Ovarian neoplasm; Ovary; Ovary-sparing; Pediatric