Background
Testicular torsion is a time-sensitive surgical emergency that may result in orchiectomy. When presentation is delayed more than 12 hours, orchiectomy rates approach 40%. Pediatric emergency departments protocols to triage acute scrotal pain to expedite intervention have mitigated system-based delays to treatment. Despite these initiatives, high rates of orchiectomy are observed likely due to delayed presentation to the emergency room. In the United States, only 12% of adults have proficient health literacy, defined as the ability to find, understand, and use information and services to inform health-related decisions. We hypothesize that lack of health literacy is associated with high rates of orchiectomy due to lack of knowledge of the diagnosis, resulting in delayed ER presentation.
Methods
A single center administrative database was queried from October 2015 to March 2023 to identify patients with the diagnosis of acute intravaginal testicular torsion that underwent either orchiectomy and contralateral orchidopexy (orchiectomy group) or bilateral orchidopexy (preservation group). Patients < 8 years old were excluded to isolate peripubertal and pubertal age cohorts. Health literacy estimates were obtained from University of North Carolina health literacy map, which estimates health literacy in census block data. Average health literacy estimates were then categorized as 1st, 2nd, 3rd, and 4th quartile based on national data. Census block data was converted to approximate zip code, and used to assign average health literacy per zip code. Zip codes were classified as urban, suburban, rural based on Rural-Urban Commuting Areas (RUCA) classification.
Results
1044 patients underwent surgery for testicular torsion, 942 patients met all inclusion criteria. In this cohort, 304 patients (32.3%) underwent orchiectomy and contralateral orchidopexy, and 638 (67.7%) underwent bilateral orchiopexy. Health literacy estimates per zip code were obtained for 871 patients, which was the cohort used for analysis. Median age at surgery was 14.2±1.89 years for the orchiectomy group and 13.8±2.0 for the preservation group(p=0.012). Average health literacy per zip code for orchiectomy group was 239.17±11.25 and 241.6±12.5 for the preservation group (p<0.05). Of the patients who underwent orchiectomy, 74.1% patients came from zip codes with the lowest 2 quartiles compared to 64.9% in the preservation group (p<0.001) (Figure 1). On multivariate analysis, lower health literacy was significantly associated with an increased risk of orchiectomy. There was no significant difference was seen between the orchiectomy and preservation groups regarding urban, suburban, rural zip codes (Table 1).
Conclusions
Our study reveals a correlation between lower rates of health literacy and increased rates of orchiectomy, possibly due to lack of knowledge regarding the signs of acute torsion. By analyzing data on specific zip codes, we can develop a targeted education plan to improve health literacy and knowledge of testicular torsion to continuously decrease orchiectomy rates in cases of testicular torsion.
