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Contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health
Alexandra R Siegal1, Farimata Mbaye1, Chih Peng Chin1
1Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Timely orchioxy for cryptorchidism remains a challenge, with disparities affecting minority and publicly insured boys. The COVID-19 pandemic exacerbated these issues, particularly for publicly insured patients post-pandemic.
Area of Science:
- Pediatric Urology
- Health Disparities
- Surgical Timeliness
Background:
- Health disparities in timely orchiopexy for cryptorchidism are documented for Hispanic and African American males and publicly insured individuals.
- The COVID-19 pandemic has significantly impacted healthcare systems and pediatric urology care delivery.
Purpose of the Study:
- To assess if specific demographic groups experienced disproportionate effects on orchiopexy progression after cryptorchidism diagnosis during and after the COVID-19 pandemic.
- To analyze trends in timely orchiopexy for pediatric cryptorchidism in US children's hospitals.
Main Methods:
- Retrospective analysis of pediatric patients (≤5 years) who underwent orchiopexy between January 2018 and December 2022 using the PHIS database.
- Exclusion criteria included prematurity, retractile testes, and testicular torsion.
- Primary outcomes were age at orchiopexy and the proportion of patients undergoing timely orchiopexy.
Main Results:
- Non-Hispanic Black and Hispanic males had significantly delayed orchiopexy compared to white males.
- During the pandemic, white patients showed an increased proportion of timely surgeries and a lower median age at orchiopexy.
- Publicly insured patients consistently had lower rates of timely orchiopexy and longer delays; this disparity worsened post-pandemic.
- Patients in the Western US region experienced delays, though the pandemic saw improved timeliness in this region.
Conclusions:
- A significant proportion of patients did not receive timely orchiopexy, irrespective of insurance, race, or location.
- The COVID-19 pandemic exacerbated existing disparities, particularly for publicly insured children, with worsening outcomes post-pandemic.
- Targeted interventions are necessary nationwide to improve timely orchiopexy rates for all boys diagnosed with cryptorchidism.
Introduction:
When evaluating the timeliness of orchiopexy for cryptorchidism, health disparities are apparent among Hispanic and African American males and those with public insurance. Since the publication of these data, the COVID-19 pandemic has stressed our healthcare system and significantly affected the provision of pediatric urology care.
Objective:
We sought to assess if certain groups were disproportionately affected in progression to orchiopexy after the diagnosis of cryptorchidism during and after the pandemic in US freestanding children's hospitals.
Study Design:
Using the PHIS database, pediatric patients ≤5 years who underwent orchiopexy between January 2018 and December 2022 were retrospectively analyzed. Exclusion criteria included prematurity, retractile testes, and testicular torsion. Primary outcomes were age at orchiopexy and the proportion of individuals undergoing timely orchiopexy for cryptorchidism.
Results:
Over the study period 3140 patients ≤5 years old underwent orchiopexy for cryptorchidism. Non-Hispanic Blacks and Hispanics were significantly less likely to have timely orchiopexy and underwent orchiopexy 2.13 and 3.60 months later compared to whites (p < 0.01). As compared to pre-COVID-19, during the pandemic the proportion of patients who had timely surgery was higher and the median age was significantly lower (p = 0.01 and p < 0.01, respectively) in white patients only. Over the study period, patients with public insurance were less likely to have timely orchiopexy and underwent orchiopexy 2.94 months later (p < 0.01) than patients with private insurance. Compared to during the pandemic, post-pandemic a significantly lower proportion of publicly insured patients have since undergone timely orchiopexy (p = 0.04). Patients in the West were less likely to have timely orchiopexy and had a higher age at time of orchiopexy (p < 0.01) than other regions. However, in the West during the pandemic, the proportion of children who had timely surgery was higher compared to pre-and post-COVID-19 (p < 0.01).
Discussion:
Overall, regardless of insurance status, race, or location, a significant proportion of patients did not undergo timely orchiopexy. During the pandemic white patients had a lower median age and an increased proportion underwent timely orchiopexy, despite the number of orchiopexies remaining constant. Disparities in the post-COVID-19 era have been further exacerbated for publicly insured patients, who a significantly lower proportion of have since undergone timely orchiopexy. Specific efforts are required across the United States to increase timely orchiopexy for all boys.
Conclusions:
Progression to timely orchiopexy remains low for all boys in the era surrounding COVID-19; certain groups appear to be more adversely affected.
