Practice Patterns Affecting Delays in Care of Testicular Torsion

Abstract

To compare impact of day or on-call team, pediatric or adult attending, and patient age on testicular torsion management and outcomes. A retrospective study of patients with testicular torsion between 2012 and 2022 at a single institution was conducted. Variables impacting management time were assessed using univariate analyses. 134 patients were included: 49 underwent orchiectomies and 84 underwent orchiopexies. There was no significant difference between efficiency of on-call versus day team regarding time to ultrasound or time to operating room (OR). There were no significant differences between pediatric versus adult attending surgeons for time to surgery, intraoperative length of surgery, or testicular salvage rates. However, when patients were stratified by age greater or younger than 18 years, older patients had significantly longer symptom duration (91.9 vs 20.0 min, p = 0.005), time to receive an ultrasound from emergency room (ER) registration (152 vs 87 min, p < 0.001), time to OR from ER registration (268 vs 185 min, p < 0.001), and time to OR from ultrasound read (187 vs 123 min, p = 0.03). Older patients also had lower rates of testicular salvage approaching significance (orchiectomy rate 48.8% vs 31.5%, p = 0.057). While no significant delays in testicular torsion management were detected between management by on-call versus day team nor pediatric versus adult attending, increased age of patient was associated with delays in definitive surgical management. Greater index of suspicion for testicular torsion diagnosis in adult patients may improve the rate of testicular salvage.