title: Factors related to the time to cryptorchidism surgery--a nationwide, population-based study in Taiwan.
abstract: OBJECTIVE
  Current guidelines recommend that the optimal timing for cryptorchidism surgery is by the age of 12 months. This study investigated the trend of surgical timing and examined the factors associated with time to surgery for cryptorchidism in Taiwan by using a nationwide, population-based database.
  
  
  METHODS
  The present study utilized the Longitudinal Health Insurance Database 2005, a subset of the National Health Insurance Research Database, which contains data on all paid medical benefit claims over the period 1997-2007 for a subset of 1 million beneficiaries randomly drawn from 22.72 million individuals enrolled in the National Health Insurance program in 2005. We analyzed the timing of surgery in boys younger than 18 years with diagnosis of cryptorchidism.
  
  
  RESULTS
  We identified 547 boys who underwent surgery under 18 years of age. Approximately 79.2% of study participants received surgery after the age of 12 months. A multivariate analysis showed that several factors were significantly associated with time to surgery: age of the physician making the diagnosis, age of the surgeon performing the surgery, age of the patient at the first diagnosis of cryptorchidism, and number of previous clinic visits with the diagnosis of cryptorchidism and urbanization level of the patient's residence.
  
  
  CONCLUSIONS
  A surprisingly high rate (79.2%) of all study participants underwent surgery beyond the optimal timing. Certain doctor and patient factors were associated with time to cryptorchidism surgery. Improving the alertness and education of parents and specialists may lead to earlier surgeries.
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; National Health Insurance Dispute Mediation Committee, Department of Health, Executive Yuan, Taipei, Taiwan; Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan.
authors.forename: Yu-Fen
authors.initials: YF
authors.lastname: Chen
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; National Health Insurance Medical Expenditure Negotiation Committee, Department of Health, Executive Yuan, Taipei, Taiwan.
authors.forename: Wei-Yi
authors.initials: WY
authors.lastname: Huang
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Kuo-How
authors.initials: KH
authors.lastname: Huang
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ju-Tong
authors.initials: JT
authors.lastname: Hsieh
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chung-Fu
authors.initials: CF
authors.lastname: Lan
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hongchiangchang@ntu.edu.tw.
authors.forename: Hong-Chiang
authors.initials: HC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000367:Age Factors; D003456:Cryptorchidism / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D056126:Orchiopexy; D010818:Practice Patterns, Physicians'; D012424:Rural Population / Q000706:statistics & numerical data; D013624:Taiwan; D061665:Time-to-Treatment; D014505:Urban Population / Q000706:statistics & numerical data
keywords: cryptorchidism; infertility; orchiopexy; surgery; testicular cancer; undescended testis