Neighborhood Disadvantage Lacks Correlation With Delayed Orchiopexy for Congenital Cryptorchidism

Orchiopexy for congenital cryptorchidism is ideally performed by 18 mo of age to optimize patient outcomes. This study aims to determine whether surrogates for neighborhood disadvantage-Social Vulnerability Index (SVI) and Area Deprivation Index (ADI)-correlate with risk for delayed orchiopexy.

We conducted a retrospective cohort study at a single tertiary care pediatric hospital of patients under 18 y old who underwent orchiopexy for cryptorchidism from January 1, 2013 to December 12, 2023. Orchiopexies for other indications were excluded. The primary outcome was age at referral and intervention. Additional data included demographics, comorbidities, unilaterality versus bilaterality, one- versus two-stage procedure, and complications. High-risk SVI was defined as ≥ 90th percentile, and ADI was stratified into quartiles. Nonparametric continuous data are shown as median/interquartile range (IQR), and categorical as frequencies/percentages. Chi square and Fisher exact test were used to compare categorical data.

A total of 149 patients were evaluated. Age at referral and surgery were right-skewed distributions; therefore, median was used for analysis. Median (IQR) age was 10.5 mo (4.5-114.6) at time of referral and 15.6 mo (12.2-121.7) at time of surgery. Fifty-three point seven percentage had surgery by 18 mo. Twenty-nine patients required bilateral orchiopexy, with the second procedure occurring at a median (IQR) age of 25.2 mo (16.7-132.6). Twenty patients (14.3%) were high-risk SVI. Patients were equally distributed between ADI quartiles: 1st 25%, 2nd 25.7%, 3rd 26.4%, and 4th 22.9%. Median referral age for high-risk SVI was not significantly different from low-risk SVI (7.0 versus 11.1 mo, P = 0.14) or between ADI quartiles (P = 0.78). Median intervention age also showed no difference between high- and low-risk SVI (17.3 versus 15.5 mo, P = 0.26) or between ADI quartiles (P = 0.73). For those that required bilateral intervention, neither SVI status nor ADI quartile had significant difference in age at their second surgery (P = 0.51, P = 0.74). The overall complication rate was 14.1%. Five point four percentage were short-term: two contact dermatitis, one superficial Surgical Site Infection, four fevers of unknown origin, and one epididymitis. Eight point seven percentage were long-term: seven testicular atrophy and six recurrences. There was no difference in complication rate based on SVI category or ADI quartile (P = 0.15, P = 0.34).

Forty-six point three percentage of study patients did not have an orchiopexy performed by 18 mo, which is consistent with national trends. Neighborhood disadvantage does not appear to explain this delay, as there was no correlation with either SVI or ADI scores. Further investigation is needed to find targetable areas of intervention to improve the rate of timely orchiopexy.