Contemporary disparities in progression to orchiopexy for cryptorchidism as reported in the Pediatric Health Information System (PHIS) database
Alexandra R. Siegal, MD1, Neha R. Malhotra, MD2, Fernando A. Ferrer, MD2, John H. Makari, MD3.
1Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2Mount Sinai Kravis Children’s Hospital, New York, NY, USA, 3Children’s Hospital and Medical Center, and University of Nebraska Medical Center, Omaha, NE, USA.
Background: When evaluating the timeliness of orchiopexy, health disparities are apparent among Hispanic and African American males and those with public or self-pay insurance. However, since the publication of these data, the healthcare system has been significantly affected by the COVID-19 pandemic. We hypothesized that certain groups were disproportionately affected in progression to orchiopexy during and after the pandemic in US freestanding children's hospitals. Methods: Using the PHIS database, we retrospectively analyzed pediatric patients who underwent surgery for cryptorchidism (CPT 54550, 54560, 54640, 54650, or 54692 and ICD10 Q53.0, Q53.1, Q53.11, Q53.112, Q53.13, Q53.2, Q53.212, or Q53.9) between January 2018 and December 2022. Male patients less than 18 years old were included, with a further focus on those ≤ 5 years. Exclusion criteria included prematurity, retractile testes (Q55.22), testicular torsion (N44.01, N44.03, 54600, 54620), and procedures performed by non-pediatric urologists or non-pediatric general surgeons. The primary outcome was age at time of surgery by year, race/ ethnicity, and insurance type. The secondary outcome was the proportion of individuals undergoing timely surgery, defined by 18 months of age. Results: 6216 patients underwent orchiopexy over the study period, 3140 of which were less than 5 years. Demographics are described in Table 1. During the study period, the median age at time of orchiopexy was significantly higher for Black and Hispanic patients compared to white patients (22.5 and 23.4 months versus 18.2, p=0.04 and <0.001, respectively). Additionally, a significantly lower proportion of Black and Hispanic patients had timely surgery (44.2% and 41.8% versus 51.3%, p=0.01 and <0.001, respectively). Patients with public insurance had a statistically higher median age than those with private insurance (22.3 months versus 17.8, p<0.001), and a lower proportion had timely surgery (44.2% versus 54.2%, p<0.001). There was no statistical difference when comparing median age or timely surgery per year to 2020. During 2020, for white patients only, median age was significantly lower and the proportion who had timely surgery was higher (p<0.001, =.01). Since 2020, a significantly lower proportion of patients with public insurance have undergone timely orchiopexy (Figure 1,Table 2, p=0.04). Conclusions: Disparities exist in progression to orchiopexy for treatment of cryptorchidism. While COVID-19 overwhelmed the healthcare system, white patients had a lower median age at time of surgery and an increased proportion underwent timely orchiopexy compared to Blacks and Hispanics during this period. Since the pandemic, a lower proportion of publicly insured patients have undergone timely surgery. Providers should consider implementing safeguards to ensure they offer all patients the opportunity for equitable care during future national healthcare stressors.
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