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

Infographic · Oct 2018 · 1 min read

In brief

Large database study of 55,893 pediatric inguinal and scrotal procedures reveals distinct practice patterns: pediatric surgeons perform 89% of hernia repairs (especially in younger patients and females), while urologists perform 83% of orchiopexies and 62% of hydrocelectomies with higher case volumes per surgeon.

Pediatric surgeons perform 89% of primary inguinal hernia repairs, particularly in younger patients and females with incarcerated hernias.
Pediatric urologists dominate orchiopexy (83%) and hydrocelectomy (62%) with higher annual case volumes than surgeons.
Median surgeon volumes are low for hernias (4/year) but higher for orchiopexy (24/year), reflecting specialty-specific referral patterns.
Overlapping surgical expertise between specialties creates opportunities to optimize training curricula and improve patient access to care.

Written by the GCMD Library team from the infographic.

A presentation slide with a teal header, blue data table in the center, and green conclusion box at the bottom. The table uses light blue rows to display surgical procedure volumes and percentages across two specialist types. A small journal cover image appears in the top right corner.

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, 3399 laparoscopic hernia repairs, 9414 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 operate 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.

The text in the image

Pediatric inguinal and scrotal surgery- Practice patterns in U.S. academic centers | Yvonne Y. Chan, Blythe Durbin-Johnson, Eric A. Kurzrock. J Peds Surg. Jul 2016, 51(11), 1786-90. | Journal of Pediatric Surgery | Pediatric Surgeon | Pediatric Urologist | Total Surgeries | Primary Hernia Repair | 23,205 (89%) | 2,868 (11%) | 26,073 | Laparoscopic Hernia Repair | 3,263 (96%) | 136 (4%) | 3,399 | Hydrocelectomy | 3,579 (38%) | 5,835 (62%) | 9,414 | Orchiopexy | 2,763 (17%) | 13,782 (83%) | 16,545 | Conclusion: | Hernia Repairs are most often performed by pediatric surgeons | Hydrocelectomy & Orchiopexy most often performed by pediatric urologists | [This Visual Abstract created by Benjamin Hazen (Northeast Ohio Medical Univ.)]

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