Design: Retrospective data from 2013 to 2022 was obtained for patients who underwent operative management for concern for torsion. We assessed outcomes based on attending division as follows: Generalist/Maternal Fetal Medicine (MFM), Gynecologic Oncology, Minimally Invasive Gynecologic Surgery (MIGS)/Reproductive Endocrinology and Infertility (REI), and Urogynecology. The primary outcome was procedure performed (oophorectomy versus cystectomy), with secondary outcomes including mode of surgery (laparoscopy versus laparotomy) and time to surgery (hours).

Setting: Single university healthcare system

Patients or Participants: Patients were included if they underwent surgery for possible torsion. Patients were excluded if sonographic images were unavailable, they did not receive an operative diagnosis, or the attending was a general surgeon. Of 477 possible patients, 237 met inclusion criteria. 23 patients with elective surgeries were excluded from the analysis of time to surgery, and only patients with torsion were modeled in the procedure performed analysis.

Interventions: N/A

Measurements and Main Results: The percent of patients who had an oophorectomy/cystectomy performed by subspecialty overall were as follows: Gynecology Oncology 70.7%/24.4%; Generalist/MFM 40.3%/42.6%; Urogynecology 48.7%/30.8%; MIGS/REI 35.7%/42.9%. MIGS/REI attendings trended towards a minimally invasive approach compared to overall (96.4% versus 89.9%). In a logistic regression analysis adjusted for age, number of times torsed, history of oophorectomy, and pregnancy status, the odds ratios (OR) and 95% confidence intervals(CI) for oophorectomy versus cystectomy among those with torsion compared to Generalist/MFM were as follows: Gynecologic Oncology 3.9 [CI 1.4,12.3], Urogynecology 3.3 [CI 0.9,14.0], MIGS/REI 2.9 [CI 0.7, 15.9]. Logistic and linear regression analyses were performed for mode and time to surgery, respectively, and differences in these outcomes across the subspecialties were not statistically significant.

Conclusion: This study suggests that Gynecologic Oncologists have increased odds of performing an oophorectomy versus cystectomy compared to Generalist/MFM attendings for management of adnexal torsion.