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Published on: November 30, 2010
Factors associated with delayed pediatric hypospadias surgery in Taiwan: a population-based, nationwide analysis
Yu-Fen Chen1, Wei-Yi Huang, Shyh-Chyan Chen
1Department of Nursing, Kang-Ning Junior College of Medical Care and Management, 7 Chung-Shan South Road, Taipei, Taiwan.
Insights
Most hypospadias repairs in Taiwan occur after 18 months, contrary to guidelines. Factors like diagnosis setting, surgeon characteristics, and patient health influence surgical timing, indicating a need for improved care quality.
Area of Science:
- Pediatric Surgery
- Urology
- Public Health
Background:
- Current guidelines recommend hypospadias repair before 18 months.
- Hypospadias repair timing is crucial for optimal outcomes.
Purpose of the Study:
- Investigate trends in hypospadias repair surgical timing in Taiwan.
- Identify factors associated with the age at which hypospadias surgery is performed.
Main Methods:
- Utilized the Longitudinal Health Insurance Database 2005 (Taiwan).
- Analyzed claims data from 1997-2007 for 218 male newborns diagnosed with hypospadias.
- Performed multivariate analysis to determine factors influencing surgical timing.
Main Results:
- 60.6% of hypospadias repairs were performed after 18 months.
- Significant factors included diagnosis/surgical specialty, physician/surgeon characteristics, patient residence urbanization, surgery modality, comorbidities (cryptorchidism, prematurity, low birth weight), age at diagnosis, and well-baby visit frequency.
- Only 89 out of 218 subjects underwent repair surgery.
Conclusions:
- Delayed hypospadias surgery is a significant issue in Taiwan.
- Multiple factors contribute to the delay, highlighting potential areas for quality improvement in pediatric care.
Background/Purpose:
Current guidelines recommend that hypospadias repair should be performed before age 18 months. This study aims to investigate the trends of surgical timing and to determine what factors are associated with age at surgery.
Methods:
The present study utilized a subset of the National Health Insurance Research Database, known as Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over the period from 1997 to 2007 for a subset of one million beneficiaries randomly drawn from the population of 22.72 million individuals in NHI program during any part of calendar year 2005. We analyzed claims data for all subjects with the diagnoses of hypospadias.
Results:
Among 52,705 live male newborns, 218 were diagnosed with hypospadias and thus were included as subjects in our study. Among them, 89 received repair surgery. Approximately 60.6% of the study subjects received repair after the age of 18 months. Multivariate analysis showed that several factors were significantly associated with age at hypospadias surgery: specialty of clinics where first diagnosis was made; specialty of physician making the first diagnosis, age of physician making the first diagnosis; specialty of surgeon performing the surgery; number of years since surgeon's board certification; urbanization level of subject's residence; modality of surgery; concomitant cryptorchidism; concomitant prematurity and low birth weight; age at diagnosis; and number of well-baby clinic visits.
Conclusion:
This study addresses an important issue of delayed hypospadias surgery in Taiwan, which provides a potential opportunity for improvement in quality of care.