Sustained Positive Practice Change After Targeted Education in the Management of Ovarian Torsion

Matthew M Byrne; Nicole A Wilson; Elizabeth Levatino; David M Powell; Marjorie J Arca

doi:10.1016/j.jpedsurg.2024.162062

Sustained Positive Practice Change After Targeted Education in the Management of Ovarian Torsion

J Pediatr Surg. 2024 Nov 10;60(1):162062. doi: 10.1016/j.jpedsurg.2024.162062. Online ahead of print.

Authors

Matthew M Byrne¹, Nicole A Wilson², Elizabeth Levatino¹, David M Powell³, Marjorie J Arca⁴

Affiliations

¹ University of Rochester Medical Center, Department of Surgery, 601 Elmwood Avenue, Box SURG, Rochester, NY, USA.
² University of Rochester Medical Center, Golisano Children's Hospital, Department of Surgery, Division of Pediatric Surgery, 601 Elmwood Avenue, Box SURG, Rochester, NY, USA.
³ Stanford School of Medicine, Department of Surgery, Division of Pediatric Surgery, 730 Welch Rd, Palo Alto, CA, USA.
⁴ University of Rochester Medical Center, Golisano Children's Hospital, Department of Surgery, Division of Pediatric Surgery, 601 Elmwood Avenue, Box SURG, Rochester, NY, USA. Electronic address: marjorie_arca@urmc.rochester.edu.

PMID: 39566447
DOI: 10.1016/j.jpedsurg.2024.162062

Abstract

Background: Failure to perform ovarian conservation surgery (OCS) for patients who present with adnexal torsion was recognized as a practice gap by the American Pediatric Surgical Association (APSA) in 2017. A targeted educational campaign was conducted to promote detorsion and ovarian conservation surgery as the standard of care for ovarian torsion. We evaluated the practice change that has occurred for pediatric and adolescent patients with ovarian torsion from 2012 to 2022.

Methods: Using the American College of Surgeons (ACS) National Safety and Quality Improvement Project-Pediatrics (NSQIP-P) Participant Use Files from 2012 to 2022, we compared surgical treatment types during the time periods that encompassed the targeted educational period.

Results: A total of 2249 patients (70 %) underwent OCS surgery and 980 (30 %) patients underwent salpingectomy and/or oophorectomy (SO). Patients who were treated with OCS were older (12.4 [SD 3.6] vs. 11.4 [SD 4.8] years, p < 0.01). Patients were more likely to be treated with SO if they were Black (11 vs. 15 %, p < 0.01) or obese (28 vs. 33 %, p < 0.01). From 2012 to 2017, 42 % of patients underwent OCS, compared to 76 % in 2018-2022 (p < 0.01). A mixed effect analysis comparing year-over-year rates of SO across pediatric surgeons and gynecologic surgeons showed a statistically significant difference in rates across specialty and time (p < 0.01), with pediatric surgeons performing fewer SOs.

Conclusion: In the treatment of ovarian torsion in pediatric and adolescent patients, we demonstrated successful adoption and sustained implementation of practice improvement coincident with the introduction of a comprehensive educational initiative.

Type of study: Retrospective cohort.

Level of evidence: IV.

Keywords: Adolescent; Detorsion; Implementation science; Medical education; NSQIP-Pediatrics; Oophorectomy; Ovarian sparing; Ovarian torsion; Pediatric; Spaced learning.