Assessment of hospital, surgeon, and geography-related factors associated with timely surgical care for undescended testes in a universal health care system
Bibliographic record
Abstract
Introduction Canada’s healthcare system aims to provide equitable access to care. Guidelines recommend surgery for undescended testes (UDT) before 18 months of age. We evaluated time-appropriate access to surgery for UDT patients in Canada. Methods We conducted a secondary analysis of UDT patients who received surgery between 2010–2018. Multivariable logistic models identified factors associated with surgery within 18 months. Results Among 19,209 UDT cases, 5186 (27.0%) had surgery within 18 months- 5051/17,947 (28.1%) orchidopexies and 135/1262 (10.7%) orchiectomies. Higher odds of timely orchidopexy were observed at teaching children’s (OR 1.52, CI 1.29–1.79, p < 0.001) and teaching non-children’s hospitals (OR 2.21, CI 1.87–2.61, p < 0.001) versus community hospitals. Hospitals with higher UDT volume (2nd–4th quartiles versus 1st quartile hospitals; >46 cases/year) were more likely to perform surgery within 18 months for both procedures (all OR>1, p < 0.05). Pediatric (OR 1.67, CI 1.53–1.84, p < 0.001) and general surgeons (OR 1.89, CI 1.58–2.26, p < 0.001) were more likely than pediatric urologists to operate within 18 months for orchidopexy, while only pediatric surgeons were more likely for to do so for orchiectomy (OR 1.95, CI 1.00–3.79, p = 0.05). Odds of surgery within 18 months declined over time for orchidopexies (OR 0.99, CI 0.97–1.00, p = 0.039) and orchiectomies (OR 0.88, CI 0.81–0.95, p = 0.001). Conclusion Fewer than 30% of UDT surgeries in Canada occurred within 18 months. High-volume and teaching hospitals, and pediatric/general surgeons, were more likely to operate within 18 months. Odds of operation within 18 months declined in recent years. Systemic factors may delay care for UDT patients in Canada.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".