Variability in surgical management of benign ovarian neoplasms in children
Variability in surgical management of benign ovarian neoplasms in children
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DOI：
10.1016/j.jpedsurg.2017.03.014
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发表时间：
2017-06-01
影响因子：
2.4
通讯作者：
Deans, Katherine J.
中科院分区：
文献类型：
--
作者：
Gonzalez, Dani O.;Cooper, Jennifer N.;Deans, Katherine J.
背景/目的：虽然大多数儿童卵巢肿瘤是良性的，可以用保留卵巢手术（OSS）治疗，但对最佳手术方法缺乏共识。我们的目的是确定与OSS管理的儿童良性卵巢肿瘤的比例，并评估在管理跨医院和specials.Methods的变异性：使用儿科健康信息系统，我们研究了2006年至2014年6-21岁的良性卵巢肿瘤卵巢切除术或OSS治疗的患者。使用Logistic混合效应模型与随机hospital effects.Results：在1164例良性卵巢肿瘤患者中，646例接受卵巢切除术，518例接受OSS，确定了手术类型的医院间变异性和预测因子。各医院OSS的比例存在显著差异（范围：21.7-76.6%）。在多变量分析中，由小儿外科医生管理的患者（相对于儿科和青少年妇科医生）（OR：0.27，95% CI：0.17-0.43，p < 0.001），年轻患者（OR：0.94/年，95% CI：0.90-0.98，p=0.007），急诊科入院的患者（OR：0.76，95% CI：0.58-0.99，p=0.04）发生OSS的可能性较小。在调整相关患者和医院特征后，医院间变异性仍然显着（p < 0.001）。结论：在医院和专业之间，良性卵巢肿瘤的管理存在显着的变异性。治疗专家之间的合作努力可能会改善OSS循证指南的实施。研究类型：回顾性研究证据等级：III。(C)2017爱思唯尔公司All rights reserved.
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 studyLevel of evidence: III. (C) 2017 Elsevier Inc. All rights reserved.