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Health Disparities in the Appropriate Management of Cryptorchidism
Kate B Savoie1, Marielena Bachier-Rodriguez1, Elleson Schurtz2
1Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN; Le Bonheur Foundation, Le Bonheur Children's Hospital, Memphis, TN.
Insights
Most children with cryptorchidism (undescended testes) in this region do not receive timely surgical repair before 18 months of age. Delays are linked to insurance status and ethnicity, suggesting potential access to care issues.
Area of Science:
- Pediatric Surgery
- Urology
- Public Health
Background:
- Cryptorchidism, or undescended testes, requires timely surgical correction, ideally by 18 months, to optimize outcomes.
- Regional variations in surgical management practices for pediatric conditions are common.
- Assessing adherence to recommended treatment timelines is crucial for evaluating healthcare quality.
Purpose of the Study:
- To evaluate the timeliness of orchiopexy for cryptorchidism in a tertiary pediatric hospital setting.
- To identify factors associated with delayed surgical correction of cryptorchidism.
- To determine complication rates related to the timing of surgical intervention.
Main Methods:
- Retrospective chart review of 1209 patients undergoing surgical correction for cryptorchidism.
- Analysis of patient demographics, insurance status, and age at surgery.
- Assessment of diagnostic imaging use, surgical procedure, and complication occurrence.
Main Results:
- The median age for surgical correction was 3.7 years, with only 27% of patients repaired before 18 months.
- African American and Hispanic patients, as well as those with public or no insurance, were less likely to receive timely repair.
- Late repair was associated with a significantly lower complication rate (3%), and no diagnostic imaging was used in most cases (72%).
Conclusions:
- A significant majority of patients experienced delayed surgical intervention for cryptorchidism, indicating potential regional access to care barriers.
- Insurance status and ethnicity are associated with delays in treatment.
- Community physician and patient education may improve timely referrals and surgical management.
Objective:
To assess regional practices in management of cryptorchidism with regard to timely fixation by the current recommended age of 18 months.
Study Design:
A retrospective study was performed. Charts of all patients who underwent surgical correction for cryptorchidism by a pediatric general surgeon or urologist within a tertiary pediatric hospital in an urban setting were systematically reviewed.
Results:
We identified 1209 patients with cryptorchidism. The median age of surgical correction was 3.7 years (IQR: 1.4, 7.7); only 27% of patients had surgical correction before 18 months of age. Forty-six percent of our patients were white, 40% were African American, and 8% were Hispanic. African American and Hispanic patients were less likely to undergo timely repair (P?=?.01), as were those with public or no insurance (P?
Conclusions:
A majority of our patients were not referred for surgical intervention in a timely manner, which may reflect poor access to care in our region. Public and self-pay insurance status was associated with delayed repair. Education of community physicians and families could be potentially beneficial.