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Surgical/Imaging

(124) Trends in pediatric benign ovarian surgery and risk of subsequent ovarian surgery: an Ontario population-based study

Friday, April 4, 2025
4:30 PM - 5:45 PM ET
Location: Harbour Ballroom

    Primary Author(s)

  • Justin WJ Lim, MD (he/him/his)

    Resident Physician
    Department of Obstetrics and Gynecology, University of Toronto
    Toronto, Ontario, Canada

    • Presenting Author(s)

  • Justin WJ Lim, MD (he/him/his)

    Resident Physician
    Department of Obstetrics and Gynecology, University of Toronto
    Toronto, Ontario, Canada

    • Co-Author(s)

  • NB

    Nancy N. Baxter, MD, PhD, MBA

    Deputy Executive Dean (Research Centres)
    Faculty of Medicine and Health, University of Sydney; Li Ka Shing Knowledge Institute, St. Michael’s Hospital/Unity Health Toronto; ICES
    Toronto, Ontario, Canada

  • RS

    Rinku Sutradhar, PhD

    Senior Scientist and Biostatistician; Professor
    ICES; Institute of Health Policy, Management and Evaluation, University of Toronto
    Toronto, Ontario, Canada

  • NL

    Ning Liu, PhD

    Research Methodologist; Assistant Professor
    ICES; Institute of Health Policy, Management and Evaluation, University of Toronto
    Toronto, Ontario, Canada

  • SP

    Sho Podolsky, MSc

    Epidemiologist, Health Data Analyst
    ICES
    Toronto, Ontario, Canada

  • SK

    Sari Kives, MD, M.Sc., FRCSC (she/her/hers)

    Associate Staff Physician, Fellowship Program Director
    The Hospital For Sick Children
    Toronto, Ontario, Canada

  • LA

    Lisa Allen, MD, FRCSC (she/her/hers)

    Section Head of Gynecology
    The Hospital For Sick Children
    Toronto, Ontario, Canada

  • SG

    Sumit Gupta, MD, PhD

    Paediatric Oncologist; Associate Professor; Senior Adjunct Scientist
    The Hospital for Sick Children; Division of Haematology/Oncology, Department of Pediatrics, University of Toronto; Institute of Medical Science, University of Toronto; ICES
    Toronto, Ontario, Canada

  • AS

    Andrea Simpson, MD, MSc, FRCSC

    Associate Professor, Minimally Invasive Gynecologic Surgery
    University of Toronto, St. Michael’s Hospital
    Toronto, Ontario, Canada

    • Senior Author(s)

  • AS

    Andrea Simpson, MD, MSc, FRCSC

    Associate Professor, Minimally Invasive Gynecologic Surgery
    University of Toronto, St. Michael’s Hospital
    Toronto, Ontario, Canada

Background: There is limited population-based research on benign ovarian surgery in children and how practice patterns have changed over time. Oophorectomy may carry detrimental effects on long-term health outcomes, and it is unclear if there are factors associated with ovary-conserving surgery and how often subsequent surgeries are required.

Methods: Population-based retrospective cohort study including all children under 18 years undergoing benign ovarian surgery from 2003 – 2022 in Ontario, Canada, using administrative healthcare data capturing all hospitalization, emergency department, and procedural records at an individual level. Trends in laparoscopy, surgery at pediatric institutions, and ovarian-conserving surgery were described. Multivariable log-binomial regression analysis identified patient, surgeon, and institution factors associated with ovarian-conserving surgery. Cumulative probability of undergoing subsequent ovarian surgery up to 20 years following initial surgery was calculated using Kaplan–Meier estimates.

Results: A total of 3,452 children underwent benign ovarian surgery between 2003 and 2022 in Ontario, with 2,827 (81.9%) ovarian-conserving surgeries and 625 (18.1%) oophorectomies performed. Over the study period, there was an increase in laparoscopy (63% to 83%), surgeries at pediatric hospitals (32% to 56%), and ovarian-conserving surgeries (80% to 87%), evaluated by the Cochrane-Armitage test (p < 0.0001). Multivariable log-binomial regression analysis identified several factors associated with ovarian-conserving surgery: laparoscopy (RR 1.40, 95% CI 1.33–1.47, p< 0.0001), female surgeons (RR 1.04; 95% CI 1.01–1.07, p = 0.0057), and non-gynecologist (RR 1.04; 95% CI 1.01–1.08, p = 0.0133). Ovarian-conserving surgeries were less likely in rural patients (RR 0.93, 95% CI 0.88–0.98, p = 0.009), and in younger children aged < 5 (RR 0.84, 95% CI 0.75–0.94, p = 0.0023) and aged 5–9 years (RR 0.85, 95% CI 0.75–0.96, p = 0.0066) compared to children aged 15–17 years. Probability of subsequent ovarian surgery was more likely after ovarian-conserving surgery (cumulative incidence 0.17, 95% CI 0.13–0.22) compared to oophorectomy (cumulative incidence 0.08, 95% CI 0.05–0.11), continuing to trend upward for both.

Conclusions: Pediatric ovarian surgery in Ontario is evolving, with rising rates of laparoscopy, use of pediatric hospitals and ovarian-conserving surgeries. There are several patient/surgeon factors associated with ovarian-conserving surgery. Risk of subsequent ovarian surgery continued to rise 20 years after initial surgery for all individuals, highlighting importance of ovarian conservation where possible.