113. Pediatric and Adolescent Patients Presenting to the Emergency Department with Adnexal Mass or Torsion: Preliminary Findings of a National Cross-Sectional Study.

Adnexal mass and torsion are relatively uncommon, but potentially emergent complaints among pediatric and adolescent patients in the emergency department (ED) and surgical intervention is sometimes indicated. There is little national data evaluating surgical prevalence and outcomes within this population. This is a retrospective cross-sectional study utilizing the Nationwide Emergency Department Sample (NEDS) of hospital owned EDs throughout the United States from 2016 to 2018. Inclusion criteria included female sex, younger than 20 years old, and a diagnosis of adnexal mass or ovarian/tubal torsion by ICD-10 (International Classification of Diseases) codes. Other variables included age, ED disposition, type of hospital, region of the country, and teaching hospital status. Surgery status (binomial) was determined utilizing the ICD-10 PCS (Procedure Coding System) and included all ICD-10 CPS related to surgery on the adnexa. Descriptive and bivariate analyses were conducted to assess demographic findings and rates of admission and surgical intervention. Funded by the NASPAG Young Investigator Grant for 2021-2022. N=2,269 pediatric and adolescent patients presented to the emergency department from 2016-2018 with a diagnosis of either adnexal mass or ovarian/tubal torsion. 33.1% (n=751) of patients were admitted to the hospital and 15.1% (n=342) underwent adnexal surgery. Mean age of presentation was 15.3 years old. 63% (n=1,437) were 15 years or older and 35.7% (n=811) were 10 to 14 years old. Most of the expected payors were Medicaid (45.4%, n=1,028) and private insurance (45.5%, n=1,031). 38% of the patients presented to a hospital in the south and 25% in the northeast. 77% presented to a metropolitan, teaching hospitals, 16% metropolitan, non-teaching, and 6.3% non-metropolitan, non-teaching hospitals. There were no differences in patients who received surgery versus no surgery by insurance type, region, or urban-rural hospital distinction. There were higher odds of receiving surgery if at a teaching hospital compared to a non-teaching, metropolitan hospital (OR 1.83, 95% CI 1.2-2.7). Approximately one-third of patients with an adnexal mass or torsion diagnosis were admitted to the hospital and half of those patients ultimately received surgery. This is the first known study to date evaluating prevalence of surgical intervention within this population. Surgery was more likely at teaching hospitals; however, this study does not account for differences in acuity. Further analysis will focus on differentiation between adnexal mass and torsion, type of surgery (oophorectomy versus cystectomy), and mode of surgery (open versus laparoscopy). [ABSTRACT FROM AUTHOR]