Racial Disparities in Pediatric Ovarian Mass Management
Race, ethnicity, gender and social determinants of health have been found to impact access to pediatric surgical care and outcomes. However, there is limited research examining the effect of patient race on surgical intervention in pediatric females presenting with ovarian masses. A retrospective single-institution cross-sectional review between 2009 and 2021 was performed which included individuals with sex assigned as female at birth ≤18 years of age who underwent surgery for an ovarian mass. Socio-demographics, self-reported race, preoperative imaging and laboratory assessment, type of surgery, and final pathology were collected. Fisher's exact test was used to determine if clinical findings among three race groups and two social determinants of health metrics were different. The study included 409 distinct adnexal mass cases. 196 (48 %) of patients identified as White race, 159 (41 %) identified as Black race, and the remaining 44 (11 %) were labelled as Other race. Overall, 383 (93.6 %) cases had benign pathology and there was no difference in rate of malignancy on final pathology by race group (p = 0.862). Black patients were significantly more likely to undergo oophorectomy compared to White patients (p = 0.009). There were no differences in pre-operative evaluation, surgical management, or final pathology based on social determinants of health indices. Black females were significantly more likely to undergo oophorectomy compared to White females despite no differences rates of malignancy. The implementation of a preoperative risk stratification algorithm may mitigate racial biases in this population, however, further investigation is needed to address this disparity. Level 2.
