Factors Associated with Oophorectomy in Patients with Suspected Ovarian Torsion

Abstract

Objective:

To determine clinical factors that are associated with an increased likelihood of having oophorectomy at the time of surgery in patients with suspected ovarian torsion (OT).

Design:

This is a retrospective cohort study.

Materials and Methods:

Women <50 years of age who presented to the Boston Medical Center ED, a racially diverse urban safety net hospital, between January 1, 2009, and July 31, 2014, with a diagnosis of OT who had surgery within 1 week of presentation were retrospectively identified by ICD-9 code. Patient data (age, race, gravidity, parity, BMI, history of tubal ligation and/or oophorectomy, and affected ovary size by imaging) as well as surgical data (time from presentation to surgery, work shift when surgery occurred, intraoperative findings, pathology findings, estimated blood loss, and subspecialty of surgeon) were collected and analyzed using Fisher exact test, t-test, and Mann–Whitney U tests.

Results:

Fifty-four patients with suspected OT who underwent surgery were identified, and 42 of 54 (78%) of the suspected torsion cases had OT diagnosed at surgery. Oophorectomy was not performed in any of the non-OT cases. In patients diagnosed with OT, 25 of 42 (60%) had an oophorectomy and 17 of 42 (40%) underwent ovarian cystectomy. Patient factors associated with a higher rate of oophorectomy among the OT cases were older age (p = 0.03), higher parity (p = 0.007), and larger size of the affected ovary on imaging (p = 0.02). Having a laparotomy (p = 0.04) and surgeon subspecialty were also significantly associated with performance of oophorectomy in OT cases. Gynecologic oncologists were the primary surgeons for 5 of 54 (9.3%) of the cases and were more likely than generalists and other subspecialists to remove the affected ovary (p = 0.009).

Conclusion:

Older age, higher parity, larger size of the affected ovary on imaging, having a laparotomy, and having a gynecologic oncologist perform the surgery were significantly associated with a higher likelihood of oophorectomy in OT cases. Awareness of these clinical factors may ultimately reduce unneeded oophorectomy and promote ovarian-conserving surgery. (J GYNECOL SURG 37:236)