Impact of transfer status, time to operation, and orchiectomy rates in pediatric testicular torsion: A retrospective cohort analysis.

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.