Journal of pediatric urology · 2026
Impact of transfer status, time to operation, and orchiectomy rates in pediatric testicular torsion: A retrospective cohort analysis.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Erpenbeck Sarah P, Moturu Anoosha, Ko Clifford Y, Saito Jacqueline M, Finkelstein Julia B, Ellison Jonathan S
Аннотация
INTRODUCTION: Testicular torsion is a time-sensitive pediatric emergency, with delays in care potentially leading to testicular loss (i.e., orchiectomy). Transfer to pediatric specialty hospitals may prolong time to operation. The National Surgical Quality Improvement Program - Pediatric (NSQIP-Ped) collects process measures for time-sensitive operations, including transfer status, defined as whether a patient was transferred to the operating hospital. Several NSQIP-Ped hospitals additionally participated in a Testicular Torsion Collaborative convened to improve torsion care processes. In this study, we sought to evaluate the association between patient transfer and testicular salvage.
PATIENTS AND METHODS: This retrospective cohort analysis included non-neonate pediatric patients (0-17 years) from the NSQIP-Ped database who underwent non-elective surgery for testicular torsion between January 2022 and May 2024. Patients with symptom duration >24 h and unknown transfer status were excluded. Orchiectomy was modeled using mixed-effects logistic regression, clustering by institution and comparing on transfer status. Median time to mobilize a patient to operative intervention was compared across transfer status and Testicular Torsion Collaborative participation using nonparametric tests.
RESULTS: Among 2801 included cases from 74 institutions, 51.0 % (1415/2801) presented directly to NSQIP-Ped hospitals, 88.0 % (2467/2801) had time to operation <4 h, and 8.7 % (244/2801) underwent orchiectomy. Testicular Torsion Collaborative institutions performed 54.0 % (1514/2801) of operations. Transfer status was not associated with orchiectomy (OR: 1.2, 95 % CI: 0.9-1.6). Non-Testicular Torsion Collaborative institutions were associated with higher odds of orchiectomy (OR: 2.3, 95 % CI: 1.5-3.4). Among transferred patients, there was no difference in median time to mobilize between transferred versus non-transferred patients (111 vs 117 min, p = 0.23). However, among Testicular Torsion Collaborative institutions, the median time to mobilize was shorter than non- Testicular Torsion Collaborative institutions (102 vs 118 min, p < 0.01).
CONCLUSION: While transfer status was not associated with differences in testicular salvage, Testicular Torsion Collaborative participation was independently associated with a reduced likelihood of orchiectomy. These results emphasize opportunities to improve testicular salvage for testicular torsion through collaboration.
PATIENTS AND METHODS: This retrospective cohort analysis included non-neonate pediatric patients (0-17 years) from the NSQIP-Ped database who underwent non-elective surgery for testicular torsion between January 2022 and May 2024. Patients with symptom duration >24 h and unknown transfer status were excluded. Orchiectomy was modeled using mixed-effects logistic regression, clustering by institution and comparing on transfer status. Median time to mobilize a patient to operative intervention was compared across transfer status and Testicular Torsion Collaborative participation using nonparametric tests.
RESULTS: Among 2801 included cases from 74 institutions, 51.0 % (1415/2801) presented directly to NSQIP-Ped hospitals, 88.0 % (2467/2801) had time to operation <4 h, and 8.7 % (244/2801) underwent orchiectomy. Testicular Torsion Collaborative institutions performed 54.0 % (1514/2801) of operations. Transfer status was not associated with orchiectomy (OR: 1.2, 95 % CI: 0.9-1.6). Non-Testicular Torsion Collaborative institutions were associated with higher odds of orchiectomy (OR: 2.3, 95 % CI: 1.5-3.4). Among transferred patients, there was no difference in median time to mobilize between transferred versus non-transferred patients (111 vs 117 min, p = 0.23). However, among Testicular Torsion Collaborative institutions, the median time to mobilize was shorter than non- Testicular Torsion Collaborative institutions (102 vs 118 min, p < 0.01).
CONCLUSION: While transfer status was not associated with differences in testicular salvage, Testicular Torsion Collaborative participation was independently associated with a reduced likelihood of orchiectomy. These results emphasize opportunities to improve testicular salvage for testicular torsion through collaboration.