title: Impact of surgeon specialty on ovarian-conserving surgery in young females with an adnexal mass.
abstract: OBJECTIVE
  To evaluate the patterns of surgical care among pediatric and adolescent females undergoing operative intervention for an adnexal mass with particular attention toward factors associated with ovarian-conserving surgery and access to gynecologic care.
  
  
  METHODS
  All female patients aged < or = 18 years undergoing surgery for an adnexal mass between January 1, 1991 and December 31, 2002 were retrospectively identified and demographic, operative, and pathologic data abstracted. Logistic regression analyses were used to identify factors independently associated with ovarian-conserving surgery and access to gynecologic care.
  
  
  RESULTS
  Eighty-two consecutive cases were identified. The median age at surgery was 15 years, and 91.7% of patients were > or = 12 years of age. A malignant ovarian neoplasm was present in 14.6% of cases. Oophorectomy was performed in 52.4% of cases, while 47.6% of patients underwent ovarian-conserving surgery. Multivariate regression analysis revealed that ovarian-conserving surgery was significantly less likely in the setting of malignancy, torsion, and an ovarian size of > or = 6 cm. The presence of a gynecologic surgeon, compared to other surgical specialties, was statistically significantly and independently associated with ovarian-conserving surgery (odds ratio [OR] 8.71, 95% confidence interval [CI] 2.12-41.41, p = .001). Post-menarchal status and age > or = 16 years were the characteristic most predictive of access to gynecologic surgical care.
  
  
  CONCLUSIONS
  In pediatric and adolescent patients, operative intervention for an adnexal mass is significantly more likely to result in ovarian conservation when performed by a gynecologic surgeon. For such patients, improved access to gynecologic consultation prior to surgical intervention may reduce the number of patients subjected to oophorectomy for benign conditions.
authors.affiliation: The Kelly Gynecologic Oncology Service, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. rbristo@jhmi.edu
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Nugent
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Victor
authors.initials: V
authors.lastname: Khouzhami
authors.forename: Harold E
authors.initials: HE
authors.lastname: Fox
mesh_terms: D000291:Adnexal Diseases / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D010048:Ovarian Cysts / Q000601:surgery*; D010049:Ovarian Diseases / Q000601:surgery; D010051:Ovarian Neoplasms / Q000601:surgery; D010052:Ovariectomy; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013396:Suction; D014102:Torsion Abnormality