Health Disparities in the Appropriate Management of Cryptorchidism

摘要

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 ??.0001). A majority (72%) of patients had no diagnostic imaging prior to surgery. A majority of patients had palpable testes at operation (85%) and underwent inguinal orchiopexy (76%); 82% were operated on by a pediatric urologist. Only 35 patients (3%) experienced a complication; those repaired late were significantly less likely to develop a complication ( P ?=?.03). There were no differences in age at time of surgery by surgeon type. 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.