K. S. Corkum1,2, T. B. Lautz1,2, E. E. Rowell1,2 1Northwestern University Feinberg School Of Medicine,Department Of Surgery,Chicago, IL, USA 2Ann And Robert H. Lurie Children’s Hospital Of Chicago,Division Of Pediatric Surgery,Chicago, IL, USA
Introduction: Multiple surgical sub-specialties are trained to perform adnexal cases involving the ovaries/gonads in pediatric and adolescent females, including pediatric general surgery, gynecology, and pediatric urology. There is limited published data on the overall distribution and volume of cases by surgical subspecialty.
Methods: The Pediatric Health Information System (PHIS) database, an administrative database representing stand-alone pediatric hospitals, was queried from 2013 to 2016 for all adnexal cases using ICD-9/ICD-10 procedure codes for ages ranging from 0 to 21 years of age. In addition to patient demographics, the principal procedure, principal diagnosis, and procedure physician sub-specialty were extracted for analysis. Two institutions were excluded from the study due to incomplete data. Surgeons were categorized into pediatric general surgeons, gynecologists, and urologists.
Results: A total of 47 institutions were included in the study with a total of 1,601 cases over the three-year study period. Median age was 14 years old [IQR 11-16]. The most common diagnosis across all procedures was an ovarian cyst (n=718, 44.8%). Laparoscopic unilateral oophorectomy (n=578, 36.1%) was the most common procedure performed. Pediatric surgeons performed 1035 (64.6%) overall cases, compared with 341 (21.3%) by gynecologists and 73 (4.6%) by urologists. Pediatric surgeons performed a significantly higher proportion of cases than the other surgical sub-specialties for children between 0 and 17 years old (p<0.001). No cases were performed by gynecologists for patients ages 0 to 1 years old or for neonatal pathology. There was no significant difference between the proportion of cases performed by pediatric surgeons and gynecologists for ages 18-21 years old. Pediatric surgeons performed significantly higher proportion of laparoscopic unilateral oophorectomy (61.9% vs 25.3%, p<0.001), open unilateral oophorectomy (76.8% vs 16.2%, p<0.001), and laparoscopic unilateral cystectomy (55.1% vs 19.5%, p<0.001) cases than gynecologist. Pediatric surgeons performed a significantly higher proportion of cases than gynecologist for most diagnoses including benign/malignant ovarian mass (69.8% vs 19.9%, p<0.001), ovarian torsion (65.8% vs 27.6%, p<0.001), and ovarian cyst (68.0% vs 22.4%, p<0.001). In patients with disorders of sex development, urologist performed a higher proportion of cases than both pediatric surgeons and gynecologists (69.7% vs 13.9% vs 13.9%, p<0.001).
Conclusion: Pediatric surgeons perform the majority of adnexal operations at stand-alone pediatric hospitals, with the exceptions of children with a disorder of sex development, patients between 18 and 21 years old, and bilateral oophorectomy cases. Pediatric surgeons should be included in adnexal cases involving a neonate, infant, or young child because of their operative experience and technical facility with advanced minimally invasive surgery in children.