Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Thomas E Schroeder; Kaeli K Samson; Ellen Kerns; Claudia Berrondo

doi:10.7759/cureus.25711

Impact of Healthcare Disparities on Time to Surgery for Pediatric Urologic Patients

Cureus. 2022 Jun 7;14(6):e25711. doi: 10.7759/cureus.25711. eCollection 2022 Jun.

Authors

Thomas E Schroeder¹, Kaeli K Samson², Ellen Kerns³, Claudia Berrondo^{1

4}

Affiliations

¹ Urology, University of Nebraska Medical Center, Omaha, USA.
² Biostatistics, University of Nebraska Medical Center, Omaha, USA.
³ Pediatrics, University of Nebraska Medical Center, Omaha, USA.
⁴ Pediatric Urology, Children's Hospital & Medical Center, Omaha, USA.

Abstract

Introduction Healthcare disparities are differences in health outcomes reflecting social inequalities. We aim to identify healthcare disparities in pediatric urologic patients by analyzing the time from surgical scheduling to completion of procedure at a single center and identify variables associated with increased time to surgery. Materials and methods We reviewed all patients aged 0-18 years who underwent surgery with one of three pediatric urologists at our institution from January 1, 2018, to December 31, 2019. We collected or calculated variables including age, sex, race, ethnicity, caregivers' primary language, insurance status, zip code, median distance to hospital, clinic visit date, and time to surgery (calculated as days between surgery request and date of surgery). Data analysis included bivariate analysis and linear regression with all variables of interest presented with 95% confidence intervals (CIs), where log-transformed time to surgery was the outcome. Because the practice at our institution is to delay elective surgeries until after six months of age, we excluded patients who were less than six months of age at the time of surgery request date. Results A total of 697 patients were included in the final analysis. Patients' caregivers who spoke languages other than English or Spanish had a lower model-adjusted mean log-days to surgery (-0.44; 95% CI: -0.85, -0.03) relative to English-speaking caregivers. Uninsured patients had increased time to surgery compared to Medicaid patients (0.28; 95% CI: 0.03, 0.53). Income was also associated with increased time to surgery, meaning patients from higher-income backgrounds had a longer time to surgery (0.04; 95% CI: 0.00, 0.08). Conclusions In our patient population, primary language spoken and insurance status were associated with increases in time from initial evaluation to surgical intervention among pediatric patients undergoing urologic surgery. Additional research is needed to better understand variations in access to pediatric urologic surgery.

Keywords: healthcare inequality; pediatric urology; population-based study; sociodemographic differences; time to surgery.