title: Timing of orchiopexy in the United States: a quality-of-care indicator.
abstract: OBJECTIVE
  To investigate whether orchiopexies are occurring later than recommended by American Academy of Pediatrics 1996 guidelines (around age 1). Adherence to guidelines is poorly studied.
  
  
  METHODS
  The main cohort consisted of 4103 boys insured from birth (Innovus i3, insurance claims database). The complementary cohort consisted of 17 010 insured and noninsured boys (Pediatric Health Information System, PHIS). The inclusion criteria was age ≤ 5 years at time of International Classification of Disease, 9th revision-defined cryptorchidism diagnosis. The primary outcome was timely surgery (orchiopexy by age 18 months).
  
  
  RESULTS
  In Innovus, 87% of boys who underwent an orchiopexy had a timely orchiopexy. Of those who did not undergo surgery (n = 2738), 90% had at least 1 subsequent well-care visit. Those who underwent timely surgery were referred to a surgeon at a younger age compared with those who underwent late surgery (4.1 vs 16.1 months, P < .00005). Predictors of timely surgery were number of well-care visits (odds ratio 1.5, 95% confidence interval 1.3-1.7), continuity of primary care (odds ratio 1.9, 95% confidence interval 1.3-2.7), and use of laparoscopy (odds ratio 4.5, 95% confidence interval 1.4-14.9). Family/internal medicine as referring provider was predictive of delayed surgery (odds ratio 0.5, 95% confidence interval 0.3-0.8). In the Pediatric Health Information System, 61% of those with private insurance had timely surgery compared with 54% of those without private insurance (P < .0001).
  
  
  CONCLUSIONS
  We found an unexpectedly high adherence to guidelines in our continuously insured since birth Innovus population. Primary care continuity and well-care visits were associated with timely surgery. Further studies can confirm these findings in nonprivately insured patients with the ultimate goal of instituting quality improvement initiatives.
authors.affiliation: Department of Urology, University of California Los Angeles, Los Angeles, California 90095-1738, USA. jennyyiee@yahoo.com
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Yiee
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
authors.forename: Julie
authors.initials: J
authors.lastname: Lai
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Copp
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Churchill
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D002675:Child, Preschool; D003456:Cryptorchidism / Q000601:surgery*; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D061646:Operative Time; D056126:Orchiopexy / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care; D016896:Treatment Outcome; D014481:United States