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

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Omling, ErikLund University,Lunds universitet,Pediatrik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Kirurgi och folkhälsa,Forskargrupper vid Lunds universitet,Barnkirurgi,Paediatrics (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Surgery and public health,Lund University Research Groups,Pediatric surgery (author)

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

Article/chapterEnglish2020

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2020-09-22
BMJ,2020

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LIBRIS-ID:oai:lup.lub.lu.se:76abe387-0b76-4d89-8e4d-bf2e3fb4ab1d
https://lup.lub.lu.se/record/76abe387-0b76-4d89-8e4d-bf2e3fb4ab1dURI
https://doi.org/10.1136/bmjpo-2020-000741DOI

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Language:English
Summary in:English

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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.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.

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Bergbrant, SannaLund University (author)
Persson, AndreasLund University,Lunds universitet,Centrum för geografiska informationssystem (GIS-centrum),Institutionen för naturgeografi och ekosystemvetenskap,Naturvetenskapliga fakulteten,Centre for Geographical Information Systems (GIS Centre),Dept of Physical Geography and Ecosystem Science,Faculty of Science(Swepub:lu)ngeo-ape (author)
Björk, JonasLund University,Lunds universitet,Centrum för ekonomisk demografi,Ekonomihögskolan,Avdelningen för arbets- och miljömedicin,Institutionen för laboratoriemedicin,Medicinska fakulteten,Kirurgi och folkhälsa,Forskargrupper vid Lunds universitet,EPI@LUND,Centre for Economic Demography,Lund University School of Economics and Management, LUSEM,Division of Occupational and Environmental Medicine, Lund University,Department of Laboratory Medicine,Faculty of Medicine,Surgery and public health,Lund University Research Groups(Swepub:lu)ymed-jbj (author)
Hagander, LarsLund University,Lunds universitet,Pediatrik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Kirurgi och folkhälsa,Forskargrupper vid Lunds universitet,Barnkirurgi,Paediatrics (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Surgery and public health,Lund University Research Groups,Pediatric surgery,Skåne University Hospital(Swepub:lu)med-lhd (author)
Pediatrik, LundSektion V (creator_code:org_t)

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By the author/editor: Omling, Erik; Bergbrant, Sanna; Persson, Andreas; Björk, Jonas; Hagander, Lars

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Pediatrics

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Health Sciences; and Public Health Gl ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Surgery

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