Pediatric inguinal and scrotal surgery - Practice patterns in U.S. academic centers

Area of Science:

• Pediatric Surgery
• Pediatric Urology
• Surgical Outcomes Research

Background:

• Pediatric surgeons and urologists share overlapping expertise in common pediatric surgical procedures.
• Understanding the distinct roles and referral patterns between these specialties is crucial for optimizing patient care and training.

Purpose of the Study:

• To investigate and compare the procedural distribution between pediatric surgeons and pediatric urologists.
• To test the hypothesis that pediatric surgeons perform more incarcerated and female hernia repairs, while urologists perform more orchiopexies and hydrocelectomies.

Main Methods:

• A retrospective analysis of the Vizient-AAMC Faculty Practice Solutions Center® database (2009-2014).
• Inclusion criteria: patients ≤10 years old undergoing hernia repair, hydrocelectomy, or orchiopexy by pediatric specialists.
• Data analyzed included procedure type, patient demographics, and surgeon volume.

Main Results:

• Over 55,000 surgeries were identified, with pediatric surgeons performing 89% of primary hernia repairs and pediatric urologists performing 62% of hydrocelectomies and 83% of orchiopexies.
• Pediatric surgeons managed more incarcerated and female hernia repairs and operated on younger patients.
• Pediatric urologists demonstrated higher median annual volumes for hydrocelectomies (6) and orchiopexies (24) compared to pediatric surgeons for hernia repairs (4).

Conclusions:

• Pediatric surgeons are the primary providers for inguinal hernia repairs, particularly in younger patients and females.
• Pediatric urologists predominantly manage hydroceles and orchiopexies, often related to undescended testes in boys.
• Clarifying these specialty-specific referral patterns can enhance surgical training and improve access to care.