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Racial and ethnic disparities in the timing of orchiopexy for cryptorchidism
Jennifer J Ahn1, Michelle M Garrison2, Paul A Merguerian1
1University of Washington, Department of Urology, USA; Seattle Children's Hospital, Division of Pediatric Urology, USA.
Insights
Racial and ethnic minorities with cryptorchidism experience delayed orchiopexy (surgery for undescended testes), increasing risks for infertility and malignancy. Further research is needed to address these healthcare disparities.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Health Disparities
Background:
- Timely surgery for cryptorchidism is crucial to mitigate risks of infertility and malignancy.
- Existing research suggests potential racial and ethnic disparities in surgical timing, but this is underexplored in pediatric urology.
Purpose of the Study:
- To investigate the association between race and ethnicity and the age at which children undergo orchiopexy.
- To identify potential disparities in the timing of orchiopexy based on patient race and ethnicity.
Main Methods:
- Retrospective cohort study using the NSQIPP PUF (2012-2016) of patients under 18 years old.
- Exclusion of patients with cancer.
- Primary outcome: age at orchiopexy; Secondary outcome: proportion of patients receiving surgery by the recommended age.
Main Results:
- The median age for orchiopexy was 17.4 months; 51% of patients had surgery by 18 months.
- Non-Hispanic white patients had higher rates of timely orchiopexy (56%) compared to non-Hispanic black patients (44%).
- Hispanic and black patients experienced average delays of 5 and 7 months, respectively, compared to white patients after adjusting for covariates.
Conclusions:
- While overall orchiopexy timing appears to be improving, significant racial and ethnic disparities persist.
- Minority patients are older at the time of orchiopexy, potentially elevating risks for future infertility or malignancy.
- Further investigation into patient, provider, and system-level factors is necessary to address these disparities in surgical timing.
Introduction:
Many children do not undergo surgery for cryptorchidism in a timely fashion, increasing risk of infertility and malignancy. Racial and ethnic disparities in surgery timing has been suggested in other specialties, but has not been well-explored in Pediatric Urology.
Objectives:
Our aim was to investigate the association of race and ethnicity with age at orchiopexy.
Materials And Methods:
We performed a retrospective cohort study of individuals <18 years of age as captured in the NSQIPP PUF from 2012 to 2016. Those with cancer were excluded. The primary outcome of interest was age at time of surgery. Secondary outcome was the proportion of individuals undergoing surgery by recommended age. Generalized linear models and logistic regression models were created for the outcomes of interest.
Results:
The median age at orchiopexy was 17.4 months (10.7, 43.0) and overall, 51% of subjects underwent orchiopexy by 18 months of age. Non-Hispanic white individuals were most likely to have undergone orchiopexy by 18 months of age, at 56%, compared with only 44% of non-Hispanic black individuals (p < 0.001). When adjusting for co-morbidities and developmental delay, Hispanic patients underwent orchiopexy 5 months later than white patients, on average, and black patients had a delay of 7 months compared to white patients.
Discussion:
These data suggest that orchiopexy is happening at younger ages compared to prior large-scale studies. However, minority patients are on average older at time of orchiopexy, potentially increasing future risk of infertility or malignancy. While an estimated average delay of 5-7 months may not seem high, studies suggest there is an appreciable change in risk with a 6-month delay. Patient, provider, and system-level factors likely all contribute, and these need to be further elucidated.
Conclusions:
Many racial and ethnic minorities with cryptorchidism have later orchiopexies, and are more likely to have surgery outside the recommended timeframe. Further investigation is warranted to determine the factors contributing to these disparities.
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