Advertisement

Changing practices in the surgical management of adnexal torsion: an analysis of the national surgical quality improvement project (NSQIP) database

      Objectives

      In November 2016, the American College of Obstetrics and Gynecology (ACOG) released updated clinical guidelines recommending ovarian conservation over oophorectomy for adnexal torsion. Our primary objective was to evaluate trends in the surgical management of adnexal torsion before and after the publication of these guidelines.

      Materials and Methods

      We performed a retrospective cohort study using the NSQIP database. Women who underwent surgery for adnexal torsion between 2008 and 2019 were identified based on postoperative Internal Classification of Diseases (ICD) codes. Surgeries were grouped as either ovarian conservation or oophorectomy using Current Procedural Terminology (CPT) codes. To assess for abrupt changes in surgical management patterns, management in the 3 years before and after 2017 were compared (2014-2016 vs. 2017-2019) using logistic regression. An interrupted time series analysis was performed to assess trends in surgical management over the entire study period (2008-2019) and changes in trends with respect to the beginning of 2017.

      Results

      Of the 617 surgeries performed for adnexal torsion during the study period, 226 (37%) involved ovarian conservation and 391 (63%) involved oophorectomy. Older age, higher BMI, and diagnosis of hypertension were significantly associated with oophorectomy (Table 1). Compared to the time period before 2017, surgeries performed after 2017 were less likely to involve oophorectomy (40.7% vs. 69.0%, OR = 0.31, 95% CI = 0.21 to 0.46); this remained true when limited exclusively to the 3-year period prior to and after 2017 (40.7% vs. 66.5%, OR = 0.34, 95% CI = 0.22 to 0.53). There was a significant decrease in proportion of oophorectomies performed each year overall (-3.8%/year, 95% CI = -5.1% to -2.6%); this trend was significant in the study period prior to 2017 (-2.1%/year, 95% CI = -3.9% to -0.1%) and after 2017 (-5.6%/year, 95% CI = -11.0% to -0.1%), but not significantly different between years 2008-2016 vs. 2017-2019 (interaction p = 0.43).

      Conclusion

      We observed an abrupt decrease in the proportion of oophorectomies performed for adnexal torsion beginning in 2017, coinciding with the publication of updated guidelines by ACOG. However, despite an overall trend towards ovarian conservation, the magnitude of this trend has not changed and oophorectomy remains common in the surgical management of adnexal torsion.
      Figure thumbnail fx2
      Figure thumbnail fx1