Pediatric inguinal and scrotal surgery — Practice patterns in U.S. academic centers

Abstract

Purpose Both pediatric urologists and pediatric surgeons perform hernia repairs, hydrocelectomies and orchiopexies. We hypothesized that surgeons perform more incarcerated and female hernia repairs while urologists perform more orchiopexies and hydrocelectomies. Methods The Vizient-AAMC Faculty Practice Solutions Center® database was queried from January 2009 to December 2014 to identify patients 10 years or younger who underwent the above procedures performed by pediatric specialists. Age, gender, race, insurance, geographic region and surgeon volume were examined. Results In the study 55,893 surgeries were identified; 26,073 primary hernia repairs, 462 recurrent hernia repairs, 3,399 laparoscopic hernia repairs, 9,414 hydrocele repairs and 16,545 orchiopexies. Pediatric surgeons performed 89% of primary hernia repairs with an annual median surgeon volume of 4 cases/year. Pediatric urologists performed 62% of hydrocelectomies and 83% of orchiopexies with annual median surgeon volumes of 6 and 24, respectively. Pediatric surgeons performed all procedures in younger patients and performed more female and incarcerated hernia repairs. Conclusions Pediatric surgeons operated on younger patients and treat more patients with inguinal hernias while pediatric urologists care for more boys with undescended testes and hydroceles. This knowledge of referral patterns and care between specialties with overlapping expertise will allow improvements in training and access. LEVELS OF EVIDENCE Cost Effectiveness Study, Level of Evidence III

Variability among Canadian pediatric surgeons and pediatric urologists in the management of cryptorchidism in boys before the publication of major guidelines: a retrospective review of a single tertiary centre

“…Previous attempts to understand practice patterns between pediatric urologists and pediatric surgeons for management of UDT suggest that, when patients are referred to pediatric urologists in US academic centres, the age at referral and volume are higher compared to referrals to pediatric surgeons. 14,16 These results are consistent with our findings. However, we examined practice patterns among 2 groups of surgeons who practise in a single-payer, open-access system where UDT is managed by both specialist groups.…”

“…19 Previous investigations of age of patients with UDT in other countries including the US, Australia and Germany showed that many boys older than the age recommended by guidelines were referred for surgery. 20,16,21 A recent study in Australia indicated that there may be a second peak of UDT in boys aged 5-9 years owing to retractile testes that have developed into acquired or secondary ascended testes. 21 Therefore, the observations from the current study may not truly reflect the age at referral for all primary congenital UDTs.…”

“…Furthermore, future study of practice variations may affect patient outcomes and subsequently may become the basis for future guideline recommendations. 16…”

Epidemiological Study of Pediatric Surgery at Regional Hospital of Sorocaba between 2008 and 2012 by a Single Surgeon

“…The numbers of children who need specialized surgery are greater than the health system is capable of attending. Consequently, children have been operated by other specialties, such as urology [3]. This is brought about by negligence in essential aspects of child surgery that should be based on clinical evidence and the effective costs of the treatment, aiming at providing benefits to an escalating number of children [12].…”

“…A significant group of children have been operated by other specialties, such as urology, whereas pediatric surgeons are usually engaged in the correction of hernias (primary and recurrent), corrections using laparoscope in younger children and girls. On the other hand, pediatric urologists operate most frequently hydrocelectomies (62%), orchiopexies (83%) [3].…”