Torsion Time; A Retrospective Cohort Study to Assess Surgeon Gender Bias for Time to Operating Room with Ovarian Torsion.

Study objective: To assess the impact of surgeon gender on the timing of surgical intervention for ovarian torsion.

Design: This is a multi-center retrospective study of patients 18-50 years old, diagnosed with ovarian torsion between January 2012 and July 2023, and who underwent surgical management.

Setting: Multi-center, retrospective observational study.

Patients or participants: Patients undergoing surgery for ovarian torsion.

Interventions: The primary outcome was the time from emergency room presentation to the operating room (OR) based on the surgeon's gender. Secondary analyses included the effects of attending surgeon seniority, gender of the diagnosing clinician, time of day, and the post-graduate year (PGY) of the trainee evaluating the patient.

Measurements and main results: We included 141 subjects with ovarian torsion. The patients averaged 32±8.7 years old with a BMI of 30±7.9 and were predominantly white (54.6%) or black (19.1%). They were more often operated on by a female attending surgeon (57.4%) and initially seen by a female clinician (55.3%). Median time from presenting to the ED to entry in the OR was 396 minutes [IQR=254.5 to 627.5]. Most surgeries were performed 7am-7pm (61.7%) by attending physicians in practice >10 years (63.8%). Using linear regression models, neither the gender of the diagnosing physician (β=0.016, p=0.90) nor the operating physician (β=-0.036, p=0.78) impacted the time to OR entry. Increasing BMI reduced time to the OR by 2.6 minutes per unit (β=-0.017, p=0.03).and increasing PGY was associated with faster OR entry times, with patients arriving to the OR 31 minutes faster per PGY(β=-0.114, p=0.01).

Conclusion: Surgeon gender does not appear to impact OR timing for ovarian torsion cases. With a retrospective trial design and multiple comparisons, the findings of faster OR entry with increasing resident PGY and with increasing BMI should be seen as hypothesis-generating conclusions.