How boys and testicles wander to surgery: a nationwide cohort study of surgical delay in Sweden.
epidemiology
health services research
Journal
BMJ paediatrics open
ISSN: 2399-9772
Titre abrégé: BMJ Paediatr Open
Pays: England
ID NLM: 101715309
Informations de publication
Date de publication:
2020
2020
Historique:
received:
20
05
2020
revised:
20
08
2020
accepted:
25
08
2020
entrez:
7
10
2020
pubmed:
8
10
2020
medline:
8
10
2020
Statut:
epublish
Résumé
Early 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. In 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. Of 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)). Travel 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.
Sections du résumé
BACKGROUND
BACKGROUND
Early 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.
METHODS
METHODS
In 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.
RESULTS
RESULTS
Of 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)).
CONCLUSIONS
CONCLUSIONS
Travel 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.
Identifiants
pubmed: 33024834
doi: 10.1136/bmjpo-2020-000741
pii: bmjpo-2020-000741
pmc: PMC7509961
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000741Informations de copyright
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
J Pediatr. 2017 Jun;185:187-192.e1
pubmed: 28408128
Lancet. 2004 Apr 17;363(9417):1264-9
pubmed: 15094270
J Pediatr. 2018 Mar;194:197-203.e6
pubmed: 29331326
Acta Paediatr. 2007 May;96(5):638-43
pubmed: 17326760
N Engl J Med. 2007 May 3;356(18):1835-41
pubmed: 17476009
Pediatrics. 2016 Feb;137(2):e20152768
pubmed: 26801912
J Pediatr Urol. 2013 Oct;9(5):535-41
pubmed: 22968042
J Urol. 2011 Oct;186(4 Suppl):1595-600
pubmed: 21855929
Arch Dis Child. 2009 Nov;94(11):868-72
pubmed: 19542061
Horm Res. 2001;55(1):28-32
pubmed: 11423739
BMC Urol. 2014 Feb 28;14:23
pubmed: 24581337
Lancet. 2001 Oct 6;358(9288):1156-7
pubmed: 11597673
Int J Androl. 2011 Oct;34(5 Pt 2):e499-510
pubmed: 21831232
J Urol. 2008 Jan;179(1):314-8
pubmed: 18006016
Paediatr Perinat Epidemiol. 2017 Jul;31(4):317-327
pubmed: 28632892
Br J Surg. 2019 Nov;106(12):1623-1631
pubmed: 31386195
Int J Androl. 2008 Feb;31(1):1-11
pubmed: 17488243
Pediatrics. 1993 Jul;92(1):44-9
pubmed: 8100060
J Urol. 2011 Oct;186(4 Suppl):1601-5
pubmed: 21855921
Horm Res. 2007;68(1):46-52
pubmed: 17356291
Urology. 2000 Jul;56(1):144-8
pubmed: 10869645
Health Syst Transit. 2012;14(5):1-159
pubmed: 22894859
Pediatrics. 2014 Aug;134(2):e504-11
pubmed: 25002658
Clin Epidemiol. 2018 Mar 19;10:311-322
pubmed: 29593434
BMC Public Health. 2011 Jun 09;11:450
pubmed: 21658213
Ann Surg. 2016 Jun;263(6):1062-6
pubmed: 26855367
J Urol. 2014 Aug;192(2):337-45
pubmed: 24857650