Variability in surgical management of benign ovarian neoplasms in children.
BACKGROUND/PURPOSE
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.


TYPE OF STUDY
retrospective study LEVEL OF EVIDENCE: III.
['Gonzalez|Dani O|DO|', 'Cooper|Jennifer N|JN|', 'Aldrink|Jennifer H|JH|', 'Hewitt|Geri D|GD|', 'Fallat|Mary E|ME|', 'Minneci|Peter C|PC|', 'Deans|Katherine J|KJ|']
D000293:Adolescent D002648:Child D005260:Female D054625:Healthcare Disparities D006776:Hospitals, Pediatric D006801:Humans D016015:Logistic Models D059351:Organ Sparing Treatments D010051:Ovarian Neoplasms D010052:Ovariectomy D010818:Practice Patterns, Physicians' D012189:Retrospective Studies D062606:Tertiary Care Centers D014481:United States D055815:Young Adult
Ovarian neoplasm Pediatric Ovary-sparing Oophorectomy Adolescent Ovary