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Underutilization of Laparoscopy for Ovarian Surgeries in the Pediatric Population: A Nationwide Analysis

      Highlights

      • Oophorectomy and ovarian detorsion are common operations performed in the female pediatric population. Few studies have directly compared outcomes after laparoscopic and open approaches in the pediatric population.
      • Despite fewer overall complications and readmissions, decreased cost, and shorter length of stay, laparoscopic approaches are underutilized for pediatric ovarian procedures.

      Summary

      Purpose

      Oophorectomy and ovarian detorsion are some of the most frequent operations performed in the female pediatric population. Despite the advent of laparoscopy, many surgeons continue to utilize open surgical approaches in these patients. This study sought to compare nationwide trends and postoperative outcomes in laparoscopic and open ovarian operations in the pediatric population.

      Methods

      Females less than 21 years old who underwent ovarian operations (oophorectomy, detorsion, and/or drainage) from 2016-2017 were identified from the Nationwide Readmissions Database. Patients were stratified by surgical approach (laparoscopic or open). Hospital characteristics and outcomes were compared using standard statistical tests.

      Results

      There were 13,202 females (age 17 [14-20] years) underwent open (59%) or laparoscopic (41%) ovarian operations. The most common indications for surgery were ovarian mass (48%), cyst (36%), and/or torsion (19%) for which oophorectomy (88%), detorsion (26%), and drainage (13%) were performed most frequently. The open approach was utilized more frequently for oophorectomy (95% vs. 77% laparoscopic) and detorsion (33% vs. 16% laparoscopic), both p<0.001. A greater proportion of laparoscopic procedures were performed at large (67% vs. 61% open), teaching (82% vs. 76% open) hospitals in patients with private insurance (47% vs. 42% open), all p<0.001. Patients undergoing open procedures had significantly higher index length of stay (LOS) and rates of wound infections. Thirty-day and overall readmission rates, as well as overall readmission costs, were higher in patients who received open surgeries.

      Conclusions

      Despite fewer overall complications, decreased cost, fewer readmissions, and shorter LOS, laparoscopic approaches are underutilized for pediatric ovarian procedures.

      Type of Study

      Retrospective Comparative.

      Level of Evidence

      Level III.

      Keywords

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      References

        • Anderson S.A.
        • Beierle E.A.
        • Chen M.K.
        Role of laparoscopy in the prevention and in the treatment of adhesions.
        Semin Pediatr Surg. 2014; 23: 353-356https://doi.org/10.1053/j.sempedsurg.2014.06.007
        • Kiblawi R.
        • Zoeller C.
        • Zanini A.
        • Kuebler J.F.
        • Dingemann C.
        • Ure B.
        • et al.
        Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies.
        Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir. 2022; 32: 9-25https://doi.org/10.1055/s-0041-1739418
        • Guillén G.
        • Martín-Giménez M.P.
        • López-Fernández S.
        • Molino J.A.
        • López M.
        Results of Ovarian Sparing Surgery in Pediatric Patients: Is There a Place for Laparoscopy?.
        J Laparoendosc Adv Surg Tech. 2020; 30: 458-463https://doi.org/10.1089/lap.2019.0515
        • Michelotti B.
        • Segura B.J.
        • Sau I.
        • Perez-Bertolez S.
        • Prince J.M.
        • Kane T.D.
        Surgical management of ovarian disease in infants, children, and adolescents: a 15-year review.
        J Laparoendosc Adv Surg Tech A. 2010; 20: 261-264https://doi.org/10.1089/lap.2009.0137
        • Abbas P.I.
        • Dietrich J.E.
        • Francis J.A.
        • Brandt M.L.
        • Cass D.L.
        • Lopez M.E.
        Ovarian-Sparing Surgery in Pediatric Benign Ovarian Tumors.
        J Pediatr Adolesc Gynecol. 2016; 29: 506-510https://doi.org/10.1016/j.jpag.2016.03.009
        • Panteli C.
        • Minocha A.
        • Kulkarni M.S.
        • Tsang T.
        The role of laparoscopy in the management of adnexal lesions in children.
        Surg Laparosc Endosc Percutan Tech. 2009; 19: 514-517https://doi.org/10.1097/SLE.0b013e3181c3132e
        • Kim H.
        • Cho H.
        • Park S.
        • Park S.
        Laparoscopic ovarian surgery in children and adolescents.
        JSLS. 2015; 19 (00253)e2014https://doi.org/10.4293/JSLS.2014.00253
        • Shalev E.
        • Bustan M.
        • Romano S.
        • Goldberg Y.
        • Ben-Shlomo I.
        Laparoscopic resection of ovarian benign cystic teratomas: experience with 84 cases.
        Hum Reprod Oxf Engl. 1998; 13: 1810-1812https://doi.org/10.1093/humrep/13.7.1810
        • Mais V.
        • Ajossa S.
        • Mallarini G.
        • Guerriero S.
        • Oggiano M.P.
        • Melis G.B.
        No recurrence of mature ovarian teratomas after laparoscopic cystectomy.
        BJOG Int J Obstet Gynaecol. 2003; 110: 624-626
      1. NRD Overview n.d. https://www.hcup-us.ahrq.gov/nrdoverview.jsp (accessed October 14, 2021).

        • Saberi R.A.
        • Gilna G.P.
        • Rodriguez C.
        • Quiroz H.J.
        • Urrechaga E.M.
        • Cioci A.C.
        • et al.
        Ovarian Preservation and Recurrent Torsion in Children: Both Less Common Than We Thought.
        J Surg Res. 2022; 271: 67-72https://doi.org/10.1016/j.jss.2021.10.004
        • Campbell B.T.
        • Austin D.M.
        • Kahn O.
        • McCann M.C.
        • Lerer T.J.
        • Lee K.
        • et al.
        Current trends in the surgical treatment of pediatric ovarian torsion: we can do better.
        J Pediatr Surg. 2015; 50: 1374-1377https://doi.org/10.1016/j.jpedsurg.2015.04.018
        • Aziz D.
        • Davis V.
        • Allen L.
        • Langer J.C.
        Ovarian torsion in children: is oophorectomy necessary?.
        J Pediatr Surg. 2004; 39: 750-753https://doi.org/10.1016/j.jpedsurg.2004.01.034
      2. Adnexal Torsion in Adolescents: ACOG Committee Opinion No, 783.
        Obstet Gynecol. 2019; 134: e56https://doi.org/10.1097/AOG.0000000000003373
      3. Bailez MM. Laparoscopic Ovary-sparing Surgery in Benign Ovarian Neoplasms. In: Bax KMA, Georgeson KE, Rothenberg SS, Valla J-S, Yeung CK, editors. Endosc. Surg. Infants Child., Berlin, Heidelberg: Springer; 2008, p. 783–785. https://doi.org/10.1007/978-3-540-49910-7_106.

        • Karpelowsky J.S.
        • Hei E.R.L.
        • Matthews K.
        Laparoscopic resection of benign ovarian tumours in children with gonadal preservation.
        Pediatr Surg Int. 2009; 25: 251-254https://doi.org/10.1007/s00383-009-2336-8
      4. Incidence and Trends of Pediatric Ovarian Torsion Hospitalizations in the United States, 2000–2006 | Pediatrics | American Academy of Pediatrics n.d. https://publications.aap.org/pediatrics/article/125/3/532/72668/Incidence-and-Trends-of-Pediatric-Ovarian-Torsion?autologincheck=redirected (accessed July 6, 2022).

        • Bertozzi M.
        • Esposito C.
        • Vella C.
        • Briganti V.
        • Zampieri N.
        • Codrich D.
        • et al.
        Pediatric Ovarian Torsion and its Recurrence: A Multicenter Study.
        J Pediatr Adolesc Gynecol. 2017; 30: 413-417https://doi.org/10.1016/j.jpag.2016.11.008
        • Gilna G.P.
        • Saberi R.A.
        • O’Neil C.F.
        • Ramsey W.A.
        • Huerta C.T.
        • Langshaw A.H.
        • et al.
        Disparities in utilization of laparoscopic colectomies in pediatric Crohn’s disease.
        J Pediatr Surg. 2022; 57: 1110-1114https://doi.org/10.1016/j.jpedsurg.2022.01.030
        • Babb J.
        • Davis J.
        • Tashiro J.
        • Perez E.A.
        • Sola J.E.
        • Pandya S.
        Laparoscopic Versus Open Cholecystectomy in Pediatric Patients: A Propensity Score-Matched Analysis.
        J Laparoendosc Adv Surg Tech. 2020; 30: 322-327https://doi.org/10.1089/lap.2019.0655
        • Parelkar S.V.
        • Mundada D.
        • Sanghvi B.V.
        • Joshi P.B.
        • Oak S.N.
        • Kapadnis S.P.
        • et al.
        Should the ovary always be conserved in torsion? A tertiary care institute experience.
        J Pediatr Surg. 2014; 49: 465-468https://doi.org/10.1016/j.jpedsurg.2013.11.055
        • Walker S.K.
        • Lal D.R.
        • Boyd K.P.
        • Sato T.T.
        Management of pediatric ovarian torsion: evidence of follicular development after ovarian preservation.
        Surgery. 2018; 163: 547-552https://doi.org/10.1016/j.surg.2017.11.019
        • McGovern P.G.
        • Noah R.
        • Koenigsberg R.
        • Little A.B.
        Adnexal torsion and pulmonary embolism: case report and review of the literature.
        Obstet Gynecol Surv. 1999; 54: 601-608https://doi.org/10.1097/00006254-199909000-00025
        • Sommerville M.
        • Grimes D.A.
        • Koonings P.P.
        • Campbell K.
        Ovarian neoplasms and the risk of adnexal torsion.
        Am J Obstet Gynecol. 1991; 164: 577-578https://doi.org/10.1016/s0002-9378(11)80024-4
        • Kives S.
        • Gascon S.
        • Dubuc É.
        • Van Eyk N.
        No. 341-Diagnosis and Management of Adnexal Torsion in Children, Adolescents, and Adults.
        J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2017; 39: 82-90https://doi.org/10.1016/j.jogc.2016.10.001
        • Oltmann S.C.
        • Fischer A.
        • Barber R.
        • Huang R.
        • Hicks B.
        • Garcia N.
        Pediatric ovarian malignancy presenting as ovarian torsion: incidence and relevance.
        J Pediatr Surg. 2010; 45: 135-139https://doi.org/10.1016/j.jpedsurg.2009.10.021
        • Adeyemi-Fowode O.
        • McCracken K.A.
        • Todd N.J.
        Adnexal Torsion.
        J Pediatr Adolesc Gynecol. 2018; 31: 333-338https://doi.org/10.1016/j.jpag.2018.03.010
        • Templeman C.L.
        • Hertweck S.P.
        • Scheetz J.P.
        • Perlman S.E.
        • Fallat M.E.
        The management of mature cystic teratomas in children and adolescents: a retrospective analysis.
        Hum Reprod Oxf Engl. 2000; 15: 2669-2672https://doi.org/10.1093/humrep/15.12.2669
        • Chapron C.
        • Dubuisson J.B.
        • Samouh N.
        • Foulot H.
        • Aubriot F.X.
        • Amsquer Y.
        • et al.
        Treatment of ovarian dermoid cysts. Place and modalities of operative laparoscopy.
        Surg Endosc. 1994; 8: 1092-1095https://doi.org/10.1007/BF00705727
        • Dasgupta R.
        • Renaud E.
        • Goldin A.B.
        • Baird R.
        • Cameron D.B.
        • Arnold M.A.
        • et al.
        Ovarian torsion in pediatric and adolescent patients: A systematic review.
        J Pediatr Surg. 2018; 53: 1387-1391https://doi.org/10.1016/j.jpedsurg.2017.10.053
        • Santos X.M.
        • Cass D.L.
        • Dietrich J.E.
        Outcome Following Detorsion of Torsed Adnexa in Children.
        J Pediatr Adolesc Gynecol. 2015; 28: 136-138https://doi.org/10.1016/j.jpag.2014.04.002
      5. Ovarian masses in the child and adolescent: An American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee systematic review - ClinicalKey n.d. https://www-clinicalkey-com.access.library.miami.edu/#!/content/playContent/1-s2.0-S0022346818305669?returnurl=null&referrer=null (accessed July 6, 2022).

        • Cass D.L.
        • Hawkins E.
        • Brandt M.L.
        • Chintagumpala M.
        • Bloss R.S.
        • Milewicz A.L.
        • et al.
        Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period.
        J Pediatr Surg. 2001; 36: 693-699https://doi.org/10.1053/jpsu.2001.22939
      6. INTRODUCTION TO THE HCUP NATIONAL INPATIENT SAMPLE (NIS), 2014 n.d. https://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2014.jsp (accessed October 22, 2021).