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

## TL;DR

This study compares how pediatric and non-pediatric departments in Germany manage ovarian torsion in children and adolescents, finding significant differences in surgical approaches and hospital stays.

## Contribution

The study provides new insights into management patterns of ovarian torsion in Germany, highlighting the need for standardized protocols.

## Key findings

- Non-pediatric departments more frequently use laparoscopy and ovary-sparing procedures compared to pediatric departments.
- Oophorectomy is more common in pediatric and university hospitals.
- Hospital stays are longer in pediatric departments compared to non-pediatric ones.

## Abstract

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.