How boys and testicles wander to surgery: a nationwide cohort study of surgical delay in Sweden

BackgroundEarly orchidopexy is recommended for cryptorchidism and the surgery is increasingly centralised. The objectives were to determine the incidence, risk factors and if distance to treating hospital impacted on timely treatment of cryptorchidism.MethodsIn this observational study, all boys bor...

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Published in:	BMJ paediatrics open Vol. 4; no. 1; p. e000741
Main Authors:	Omling, Erik, Bergbrant, Sanna, Persson, Andreas, Björk, Jonas, Hagander, Lars
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 22-09-2020 BMJ Publishing Group
Series:	Original research
Subjects:	Birth weight Children & youth Clinical Medicine Cohort analysis Congenital diseases Cryptorchidism Earth and Related Environmental Sciences Epidemiology Families & family life Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Geosciences, Multidisciplinary Geovetenskap och miljövetenskap Gestational age Health Sciences Hospitals Hälsovetenskap Infertility Kirurgi Klinisk medicin Medical and Health Sciences Medical diagnosis Medicin och hälsovetenskap Multidisciplinär geovetenskap Natural Sciences Naturvetenskap Paediatric Surgery Parents & parenting Pediatrics Pediatrik Population Pregnancy Public Health, Global Health, Social Medicine and Epidemiology Risk factors Smoking Surgery Surgical outcomes Testes Sweden epidemiology health services research
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Summary:	BackgroundEarly orchidopexy is recommended for cryptorchidism and the surgery is increasingly centralised. The objectives were to determine the incidence, risk factors and if distance to treating hospital impacted on timely treatment of cryptorchidism.MethodsIn this observational study, all boys born in Sweden from 2001 to 2014 were followed in national registers to determine the incidence of cryptorchidism by levels of birth-related risk factors and social determinants. Travel time to hospital was used as the primary exposure in multivariable survival analysis, with age at surgery as main outcome.ResultsOf 748 678 boys at risk for cryptorchidism, 7351 were treated and evaluated for timing of surgery (cumulative childhood incidence 1.4%, 95% CI 1.3% to 1.5%). The incidence was clearly associated with prematurity and overdue pregnancy (HR for <32 weeks 2.77 (95% CI 2.39 to 3.21); 32–36 weeks HR 1.36 (95% CI 1.24 to 1.49); >41 weeks HR 1.19 (95% CI 1.10 to 1.29)), low birth weight (<1000 g HR 3.94 (95% CI 3.15 to 4.92); 1000–1499 g HR 3.70 (95% CI 3.07 to 4.46); 1500–2500 g HR 1.69 (95% CI 1.52 to 1.88)) and intrauterine growth restriction (small for gestational age HR 2.38 (95% CI 2.14 to 2.65); large for gestational age HR 1.26 (95% CI 1.13 to 1.42)), but not with smoking or maternal age. Each 30 min increase in travel time was associated with a reduced probability of timely treatment (HR for being treated by age 3 adjusted for risk factors and socioeconomic determinants: 0.91 (95% CI 0.88 to 0.95)). Lower income and financial support were also associated with treatment delays (adjusted HR for lowest income quintile 0.82 (95% CI 0.72 to 0.93) and for families with financial support 0.85 (95% CI 0.73 to 0.97)).ConclusionsTravel distance to treating hospital was associated with delayed treatment. ‘Not all those who wander are lost’, but these findings suggest a trade-off between centralisation benefits and barriers of geography also in elective paediatric surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2399-9772 2399-9772
DOI:	10.1136/bmjpo-2020-000741