Testicular Torsion Outcomes at A Tertiary Medical Center
Nicholas Parsa, Medical Student, Nicholas Noble, M.D., Christopher Bean, M.D..
University of Mississippi Medical Center School of Medicine, Jackson, MS, USA.
Introduction/Background: Testicular torsion is a urologic emergency that necessitates immediate surgical intervention with testicular salvage through orchiopexy or orchiectomy. Previous studies have shown that the time between the onset of pain and the start of surgical treatment significantly influences outcomes, with delayed presentation leading to higher rates of orchiectomy. 1,2 In our study, we propose that treatment delays resulting from transfers from external hospitals to our facility increase the likelihood of orchiectomy compared to patients who directly present to our emergency department.
Methods/Materials: We conducted a retrospective cohort study involving pediatric patients aged 2-18 who underwent surgical exploration at our facility for a confirmed diagnosis of testicular torsion between 2013 and 2021. Patients with more than 24 hours of pain, insufficient documentation, and those who underwent surgery for intermittent torsion were excluded. Chart review and data collection were performed using the EPIC electronic health record system following IRB approval. We gathered information on the time from symptom onset to surgical management, transfer status, distance traveled, patient demographics, and surgical outcomes/postoperative complications. All collected data were securely stored in RedCap, a web-based platform, in a de-identified format. 3,4 Statistical analysis was carried out using SPSS Statistics 28.
Results: A total of 262 patient records were reviewed, and 115 met the inclusion criteria for this study. Among them, 56 patients required transfer, covering an average travel distance of 73 miles. On the other hand, 59 patients presented directly to our facility without any transfer. The average time to surgery for transferred patients was 10.2 hours, compared to 8.5 hours (p= 0.038) for patients who presented directly. Among the transferred patients, 17 out of 56 (30.4%) required an orchiectomy, while among those who presented directly, 6 out of 59 (10.2%, p=0.007) needed the procedure.
Conclusions: Our findings clearly demonstrate that delays in receiving definitive surgical management due to patient transfers lead to poorer outcomes. This underscores the importance of local management if the initial facility has the necessary capabilities; otherwise, arrangements for expedited transfer should be made. Our results align with previous research that has shown how surgical delays can have a significant negative impact on outcomes.
References1.Castañeda-Sánchez, I., Tully, B., Shipman, M., Hoeft, A., Hamby, T., & Palmer, B. W. (2017). Testicular torsion: a retrospective investigation of predictors of surgical outcomes and of remaining controversies. Journal of Pediatric Urology, 13(5), 516-e1.2.Kass, E. J., & Lundak, B. (1997). The acute scrotum. Pediatric Clinics of North America, 44(5), 1251-1266.3.PA Harris, R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde, Research electronic data capture (REDCap) – A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81.4.PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O’Neal, L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap Consortium, The REDCap consortium: Building an
international community of software partners, J Biomed Inform. 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]
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