Practice patterns in the surgical approach for adolescent varicocelectomy

Objective: To describe practice patterns in the choice of surgical approach for adolescent varicocelectomy using the Pediatric Health Information System (PHIS) database. Methods: Hospitals enrolled in the PHIS database that reported all outpatient surgeries by CPT code from 2003 to 2012 were included. Patients at least 10 years of age whose records contained both the ICD-9 code for varicocele (456.4) and a CPT code for varicocelectomy [55550 (laparoscopic), 55530 (open inguinal), 55535 (open abdominal)] were identified. Microsurgical approach was identified by the add-on CPT code 69990. Comparisons among surgical approaches were made using one-way ANOVA, and time trend was evaluated with linear regression. Results: A total cohort of 2528 patients was identified from 38 hospitals. Laparoscopic approach was utilized in 53.6 % of patients. (n = 1354) Microsurgical approach was reported in only 2 % (n = 23) of open varicocelectomies. A subgroup analysis was performed including only those hospitals that reported varicocelectomies in every year of the study period. (n = 587) In this subgroup, 57 % of cases were performed laparoscopically (n = 333), and the trend in laparoscopic cases within this subgroup remained stable over the study period (r² = 0.00, p = 0.97). Conclusions: Laparoscopic varicocelectomy was the most commonly reported surgical approach in this cohort, and the distribution of surgical approaches appeared to remain stable between 2003 and 2012. While subinguinal microsurgical repair has become the gold standard for management of varicocele in adults with infertility, this technique does not appear to be widely adopted in adolescents, though use of an operating microscope is likely underreported in the PHIS database.