Variations in pre-operative management of adolescents undergoing elective surgery.

Objective: To understand whether preoperative care of adolescent patients differs according to two different pediatric subspecialties with respect to patient pregnancy status, drug use, and patient assent. To understand how preoperative care of adolescent patients varies with length of practice and practice setting.

Methods: A cross-sectional study surveyed 51 American Society of Pediatric Otolaryngology (ASPO) members and 108 American Pediatric Surgical Association (APSA) members. Outcomes included how often ('always', 'sometimes', 'never') participants ask adolescents (ages 12-18 years) about substance use, pregnancy, and assent for surgery. Differences according to physicians' practice duration and setting were also examined. Fisher's exact tests and Cochran-Armitage tests were applied for statistical analysis.

Results: Although ASPO and APSA members did not differ significantly in how often they ask adolescent patients about pregnancy, ASPO members were more likely to 'always' cancel elective surgery in a pregnant patient (p<0.007). ASPO members were also more likely to 'always' ask about substance use, although this difference was not significant (p<0.06). APSA members were more likely to proceed with surgery despite an adolescent's refusal (p<0.007). Physicians in both specialties with <5 years in practice were most likely to 'always' ask about pregnancy, and physicians with fewer adolescent patients in their practice were more likely to 'always' ask about substance use. Physicians in differing practice settings varied in their responses about proceeding with elective surgery in a pregnant patient (p<0.03).

Conclusion: ASPO and APSA members differ in their preoperative management of adolescent patients. Newer physicians and those with fewer adolescent patients also differ from physicians with more extensive experience with adolescents.