Assessment of hospital, surgeon, and geography-related factors associated with timely surgical care for undescended testes in a universal health care system

• <1/3 of children with undescended testes in Canada received surgical care within the recommended timeline (18 months). • High-volume and teaching hospitals, as well as pediatric surgeons and general surgeons, were more likely to operate within 18 months. • Timing of surgical care for patients with undescended testes in Canada have not improved during the study period (2010–2018). • Hospital, surgeon, and geography-related factors may be associated with delayed care for patients with undescended testes in Canada. 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. 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. 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). 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.