Nicole Hubner1, Jacob Charles Langer2, Sari Kives1, Lisa Mary Allen3. 1. Division of Endocrinology, Section of Gynecology, The Hospital for Sick Children; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. 2. Division of General and Thoracic Surgery, The Hospital for Sick Children; and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 3. Division of Endocrinology, Section of Gynecology, The Hospital for Sick Children; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. Electronic address: LAllen@mtsinai.on.ca.
Abstract
STUDY OBJECTIVE: The aim of this study was to document the change in ovarian conservation rate after ovarian torsion as a result of continuous quality improvement (CQI) measures, and to determine factors that contribute to this outcome. DESIGN: A retrospective, uncontrolled before-and-after study. SETTING: An academic children's hospital. PARTICIPANTS: Female adolescents younger than 18 years with surgically confirmed ovarian torsion from April 1, 1988 to October 15, 2013; excluding cases from 2003 (intervention period). INTERVENTIONS: Implementation of CQI measures including educational programs, collaborative care pathways, and quality review with the goal of improving ovarian conservation. MAIN OUTCOME MEASURES: Demographic characteristics, details on presentation, investigations, consultation, surgical intervention, surgical findings, pathology, postoperative course, and follow-up imaging. RESULTS: One hundred thirty-nine patients met inclusion criteria (42 pre-CQI cohort and 97 post-CQI cohort). Mean ages were 9.96 and 10.33 years, respectively. Ovarian conservation rates were 47.6% compared with 85.6%, respectively (P < .001). The following factors differed between cohorts: fever (P = .003), ultrasound completed (P = .001), time from first health care provider visit to imaging (P = .025), time from specialist consultation to surgery (P = .002), surgical start time within 1 hour of booking (P < .001), and gynecologist present in operating room (P < .001). A log-binomial regression model showed that gynecology presence in the operating room (relative risk [RR], 2.043) was associated with untwisting. Increasing time from specialist consultation to surgery (RR, 0.986 per hour) was inversely associated with untwisting. Fever at presentation was also inversely associated with untwisting (RR, 0.666). CONCLUSION: The implementation of CQI measures was associated with a significant increase in ovarian conservation rate.
STUDY OBJECTIVE: The aim of this study was to document the change in ovarian conservation rate after ovarian torsion as a result of continuous quality improvement (CQI) measures, and to determine factors that contribute to this outcome. DESIGN: A retrospective, uncontrolled before-and-after study. SETTING: An academic children's hospital. PARTICIPANTS: Female adolescents younger than 18 years with surgically confirmed ovarian torsion from April 1, 1988 to October 15, 2013; excluding cases from 2003 (intervention period). INTERVENTIONS: Implementation of CQI measures including educational programs, collaborative care pathways, and quality review with the goal of improving ovarian conservation. MAIN OUTCOME MEASURES: Demographic characteristics, details on presentation, investigations, consultation, surgical intervention, surgical findings, pathology, postoperative course, and follow-up imaging. RESULTS: One hundred thirty-nine patients met inclusion criteria (42 pre-CQI cohort and 97 post-CQI cohort). Mean ages were 9.96 and 10.33 years, respectively. Ovarian conservation rates were 47.6% compared with 85.6%, respectively (P < .001). The following factors differed between cohorts: fever (P = .003), ultrasound completed (P = .001), time from first health care provider visit to imaging (P = .025), time from specialist consultation to surgery (P = .002), surgical start time within 1 hour of booking (P < .001), and gynecologist present in operating room (P < .001). A log-binomial regression model showed that gynecology presence in the operating room (relative risk [RR], 2.043) was associated with untwisting. Increasing time from specialist consultation to surgery (RR, 0.986 per hour) was inversely associated with untwisting. Fever at presentation was also inversely associated with untwisting (RR, 0.666). CONCLUSION: The implementation of CQI measures was associated with a significant increase in ovarian conservation rate.
Authors: Alexandra Tielli; Andrea Scala; Marianne Alison; Van Dai Vo Chieu; Nicholas Farkas; Luigi Titomanlio; Léa Lenglart Journal: Eur J Pediatr Date: 2022-01-30 Impact factor: 3.183
Authors: Susan C Lipsett; Lalita Haines; Michael C Monuteaux; Katherine Hayes; Kenneth A Michelson Journal: J Pediatr Date: 2020-12-17 Impact factor: 4.406
Authors: Justyna Łuczak; Maciej Bagłaj; Piotr Dryjański; Alicja Kalcowska; Nastazja Banaszyk-Pucała; Maria Boczar; Krzysztof Dymek; Małgorzata Fryczek; Kaja Giżewska-Kacprzak; Wojciech Górecki; Andrzej Grabowski; Anna Gregor; Maria Jabłońska; Grzegorz Kowalewski; Magdalena Lewandowska; Maria Małowiecka; Anna Ogorzałek; Magdalena Pękalska; Aneta Piotrowska-Gall; Mateusz Porębski; Marek Siewiński; Dariusz Patkowski Journal: Curr Oncol Date: 2022-02-28 Impact factor: 3.677