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

Study objective — To identify factors associated with ovarian-conserving surgery in children, to examine population trends in benign ovarian surgeries over 20 years, and to evaluate long-term risk of subsequent ovarian surgeries.

Methods — We conducted a population-based retrospective cohort study of females <18 years undergoing benign ovarian surgery in Ontario, Canada (2003–2022). Factors associated with ovarian-conserving surgery were identified with multivariable log-binomial regression. Surgical trends (ovarian-conserving surgery, laparoscopy, pediatric hospital utilization) were evaluated using the Cochrane-Armitage test. Cumulative incidences of subsequent surgeries were estimated with Kaplan-Meier analysis and compared using log-rank tests.

Results — Among 3,452 children (median age 15 years), 2,827 (81.9%) underwent ovarian-conserving surgeries and 625 (18.1%) oophorectomies. Ovarian-conserving surgery was more likely with laparoscopy (RR 1.40, 95%CI 1.33–1.47), female surgeons (RR 1.04; 95%CI 1.01–1.07), and non-gynecologist (RR 1.04; 95%CI 1.01–1.08), and less likely in rural patients (RR 0.93, 95%CI 0.88–0.98) and younger children (RR 0.84, 95%CI 0.75–0.94). Although rates of surgery remained stable, there was an increase in laparoscopy (63% to 83%, p<0.0001), pediatric hospital use (32% to 56%, p<0.0001), and ovarian-conserving surgeries (80% to 87%, p<0.0001). Cumulative incidence of subsequent ovarian surgery rose with time after index operation, remaining higher after ovarian-conserving surgery than oophorectomy (p<0.0001).

Conclusions — Adoption of minimally invasive techniques and specialized pediatric care is increasing. Persistent risk of reoperation among all patients in this cohort highlights the need for strategies to ensure appropriate follow up for this at-risk group, promoting ovarian preservation, and equitable access to pediatric gynecologic expertise.