Using quality improvement methodology to improve ovarian salvage for benign ovarian masses

Jennifer H Aldrink; Dani O Gonzalez; Stephen P Sales; Katherine J Deans; Gail E Besner; Geri D Hewitt

doi:10.1016/j.jpedsurg.2017.10.016

Using quality improvement methodology to improve ovarian salvage for benign ovarian masses

J Pediatr Surg. 2017 Oct 10:S0022-3468(17)30638-3. doi: 10.1016/j.jpedsurg.2017.10.016. Online ahead of print.

Authors

Jennifer H Aldrink¹, Dani O Gonzalez², Stephen P Sales³, Katherine J Deans⁴, Gail E Besner⁵, Geri D Hewitt⁶

Affiliations

¹ Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. Electronic address: Jennifer.Aldrink@NationwideChildrens.org.
² Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH.
³ Department of Quality Improvement, Nationwide Children's Hospital, Columbus, OH.
⁴ Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH.
⁵ Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.
⁶ Department of Surgery, Division of Obstetrics and Gynecology, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH.

PMID: 29106919
DOI: 10.1016/j.jpedsurg.2017.10.016

Abstract

Purpose: Most ovarian masses in children are benign and potentially amenable to ovarian salvage surgery (OSS). Despite the common use of OSS among pediatric and adolescent gynecologists (PAG) in recognition of reproductive and hormonal health advantages, this technique is not commonly performed by pediatric surgeons. The aim of this quality improvement (QI) initiative was to improve our institutional rate of OSS for benign ovarian masses.

Methods: Baseline data were obtained retrospectively from surgical procedures performed for benign ovarian masses between January 2012 and February 2016. Designed interventions to improve the rate of OSS included the development of an ovarian mass algorithm, standardization of radiologic templates, multidisciplinary analyses of ovarian procedures, and implementation of a training model for performing OSS. Procedures performed for benign ovarian masses from March 2016 to February 2017 comprised the process stage.

Results: Our institutional baseline OSS rate was 28.8%. After implementation of the institutional algorithm, a single oophorectomy was performed for a benign mass, increasing the OSS rate to 96%. There have been no missed ovarian malignancies.

Conclusions: Utilizing preoperative risk assessment, QI methodology and multidisciplinary collaboration resulted in improved OSS rates for benign ovarian masses with no evidence of missed ovarian malignancies.

Level of evidence: Level II. This is a prospective comparative study, with comparison to a retrospective cohort. This is a quality improvement initiative without randomization.

Keywords: Benign ovarian neoplasm; Oophorectomy; Ovarian salvage; Ovarian sparing surgery; Pediatric surgery; Quality improvement.