Preservation vs. Resection? Pediatric and Non-Pediatric Management Patterns in Ovarian Torsion.

BACKGROUND

Ovarian torsion (OT) is a rare but urgent surgical condition in children and adolescents. Evidence on how management differs between pediatric (PD) and non-pediatric (Non-PD) departments in Germany remains limited.

METHODS

We conducted a retrospective cohort study using anonymized claims data from two major German statutory health insurance funds (2010-2019), covering 6.3 million insured individuals (≈1 million children). Patients ≤18 years with an inpatient diagnosis of OT (ICD-10-GM N83.5) were analyzed with respect to demographics, department type (PD vs. Non-PD), hospital type (university/maximum care [UM] vs. non-university/maximum care [Non-UM]), surgical procedures, and outcomes.

RESULTS

A total of 293 patients (mean age 12.4 ± 4.5 years) were included; 71% were adolescents (12-18 years). Adolescents were predominantly treated in Non-PD (89%), whereas younger children were more often managed in PD (50%; p < 0.0001). Most cases were treated in Non-UM (82%). Laparoscopy was more commonly used in Non-PD departments (85%), while open surgery and oophorectomy occurred more frequently in PD and university hospitals (UM). Ovary-sparing procedures accounted for 77% of all cases, whereas 23% underwent oophorectomy. Mean hospital stay was longer in PD (6.7 ± 9.0 days) than in Non-PD (4.9 ± 2.2 days; p = 0.0167). Readmission rates were comparable across groups.

CONCLUSIONS

Management of OT in Germany varies markedly by department and hospital type. PD and UM treat more younger patients but perform oophorectomy more frequently, whereas Non-PD and Non-UM favor laparoscopic, ovary-sparing strategies. These differences highlight the urgent need for standardized, evidence-based protocols prioritizing ovarian preservation and optimizing long-term outcomes in affected children and adolescents.