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Timing of orchiopexy in the United States: a quality-of-care indicator
Jenny H Yiee1, Christopher S Saigal, Julie Lai
1Department of Urology, University of California Los Angeles, Los Angeles, California 90095-1738, USA. jennyyiee@yahoo.com
Insights
Most boys with cryptorchidism received timely orchiopexies, adhering to guidelines. Continuity in primary care and regular well-child visits were linked to earlier surgical intervention for this condition.
Area of Science:
- Pediatric Surgery
- Urology
- Healthcare Quality Improvement
Background:
- Cryptorchidism, or undescended testes, requires timely surgical correction (orchiopexy) typically by 18 months of age per American Academy of Pediatrics guidelines.
- Adherence to these surgical timing guidelines is not well-documented, particularly across different insurance statuses.
Purpose of the Study:
- To evaluate the adherence to recommended surgical timing for orchiopexy in boys diagnosed with cryptorchidism.
- To identify factors associated with timely surgical intervention.
Main Methods:
- A retrospective analysis of two large healthcare databases (Innovus i3 and Pediatric Health Information System) was conducted.
- Inclusion criteria comprised boys aged ≤5 years with International Classification of Disease, 9th revision-defined cryptorchidism.
- The primary outcome was orchiopexy performed by 18 months of age.
Main Results:
- In the Innovus cohort, 87% of boys underwent timely orchiopexy. Predictors of timely surgery included more well-care visits, continuity of primary care, and use of laparoscopy.
- Family or internal medicine referrals were associated with delayed surgery.
- In the PHIS cohort, 61% of privately insured boys had timely surgery versus 54% of uninsured boys.
Conclusions:
- A high adherence to orchiopexy guidelines was observed in a continuously insured population.
- Strong associations were found between primary care continuity, well-child visits, and timely surgical management.
- Further research is needed to confirm these findings in non-privately insured populations to inform quality improvement initiatives.
Objective:
To investigate whether orchiopexies are occurring later than recommended by American Academy of Pediatrics 1996 guidelines (around age 1). Adherence to guidelines is poorly studied.
Methods:
The main cohort consisted of 4103 boys insured from birth (Innovus i3, insurance claims database). The complementary cohort consisted of 17 010 insured and noninsured boys (Pediatric Health Information System, PHIS). The inclusion criteria was age ≤ 5 years at time of International Classification of Disease, 9th revision-defined cryptorchidism diagnosis. The primary outcome was timely surgery (orchiopexy by age 18 months).
Results:
In Innovus, 87% of boys who underwent an orchiopexy had a timely orchiopexy. Of those who did not undergo surgery (n = 2738), 90% had at least 1 subsequent well-care visit. Those who underwent timely surgery were referred to a surgeon at a younger age compared with those who underwent late surgery (4.1 vs 16.1 months, P < .00005). Predictors of timely surgery were number of well-care visits (odds ratio 1.5, 95% confidence interval 1.3-1.7), continuity of primary care (odds ratio 1.9, 95% confidence interval 1.3-2.7), and use of laparoscopy (odds ratio 4.5, 95% confidence interval 1.4-14.9). Family/internal medicine as referring provider was predictive of delayed surgery (odds ratio 0.5, 95% confidence interval 0.3-0.8). In the Pediatric Health Information System, 61% of those with private insurance had timely surgery compared with 54% of those without private insurance (P < .0001).
Conclusion:
We found an unexpectedly high adherence to guidelines in our continuously insured since birth Innovus population. Primary care continuity and well-care visits were associated with timely surgery. Further studies can confirm these findings in nonprivately insured patients with the ultimate goal of instituting quality improvement initiatives.
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