Delay in Orchiopexy for Cryptorchidism:Nationwide Trends and Socioeconomic Factors
Amanda Raines, MD1, Joseph Ortenberg, MD2, Sudesh Srivastav, PhD1.
1Tulane, New Orleans, LA, USA, 2Louisiana State University, New Orleans, LA, USA.
Background: Cryptorchidism is one of the most common congenital anomalies treated by pediatric urologists -encompassing both primary and secondary undescended testes. The American Urologic Association and European Association of Urology both recommend that a congenital undescended testicle (UDT) which has not descended by 6 months of age, should undergo surgery by 18 months of age. Our goal was to evaluate the most recent nationwide data, concerning age at orchiopexy and impact of socioeconomic factors on timing of this procedure, to identify any socioeconomic barriers to optimal healthcare.Methods: We performed a retrospective review of the Nationwide Ambulatory Surgery Sample (NASS) database from the Healthcare Cost and Utilization Project (HCUP). Data was collected from 2016, 2017, and 2018. We identified patients with all ICD 10 codes for UDT and all CPT codes for orchiopexy. We evaluated multiple variables - age at orchiopexy, laterality, testicular position and surgical procedure and related this data to socioeconomic parameters - teaching versus non-teaching hospital, urban versus rural hospital setting, median household income, and payor mix. Chi-squared tests and ANOVA were used to compare proportions and means between groups with a 5% level of significance. Results: A total of 19,480 patients were identified, who had both an ICD10 code for UDT and a CPT code for orchiopexy. 62.9% of these patients were 2 years or older at the time of surgery. There was no statistically significant difference in age between surgeries performed in an urban versus rural setting (P= 0.78) or between procedures for unilateral UDT and bilateral UDT (P= 0.18). Patients with abdominal UDT did have surgery earlier than UDT in other locations, but still at older than the recommended age (2.91 years for unilateral abdominal UDT (P <0.0001) and 3.04 years for bilateral abdominal UDT (P< 0.0001). Median household income did not typically relate to a statistically significant difference in age at orchiopexy. In select instances however, there was a significant difference - the cohort of boys whose household income was the highest, had surgery at an older age (P < 0.001). There was no statistical difference between age at surgery for boys whose payor was Medicaid, Medicare, or private insurance, but the “no charge” population which was only 11 patients had surgery at an older age (P < 0.0001).Conclusions: Throughout the United States, boys with UDT are undergoing orchiopexy at an age above the recommended 18 month age limit. This is universal phenomenon, regardless of average household income, rural vs urban setting, expected payor, and teaching vs non-teaching hospital. The SPU should promote efforts to enhance education of the public and primary care providers about optimal diagnosis and treatment of cryptorchidism, to enhance the trend toward surgical correction of UDT at an earlier age.
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