Inequities and Progress in Testicular Torsion Care Following a US News & World Report Metric: A Retrospective Cohort Study

Abstract

Background and objectives

Pediatric testicular torsion is a surgical emergency with known health disparities. The US News and World Report is an American media company that ranks colleges and hospitals based on annually published criteria. Hospitals that complied with the US News and World Report’s (USNWR) Speed in Treating Testicular Torsion (SiTTT) metric saw improved surgical testicular salvage rates, but the metric’s impact in mitigating inequities in testicular torsion is unstudied.

Methods

A retrospective cohort study of patients 1–18 years of age presenting with testicular torsion was performed using the Pediatric Health Information System database. Hospitals were classified based on their SiTTT score at the metric’s onset in 2015: they were labeled complete-scoring if they achieved the maximum score and partial-scoring otherwise. Surgical testicular salvage was defined as orchiopexy without concomitant orchiectomy. Testicular salvage rates were compared based on various socioeconomic variables including race between the pre-metric (2010–2015) and post-metric (2015–2019) periods with both univariate and adjusted, multivariate analyses.

Results

We identified 3950 cases of testicular torsion: 2335 in complete-scoring hospitals and 1615 in partial-scoring hospitals. Only partial-scoring hospitals improved significantly in salvage rate (pre-metric 61.0 % vs post-metric 67.5 %, p < 0.01). Subgroup analysis revealed the largest benefit in patients with economic or communicative barriers such as those with complex chronic conditions (pre-metric 35.3 % vs post-metric 61.1 %, p < 0.05). No minority races had statistically significant improvement after the metric, and salvage rate gap between White and all other races increased (pre-metric 4.3 % vs post-metric 10.0 %, p < 0.05).

Conclusions

Patients with communicative or economic barriers showed improved equity after efforts to comply with a third-party metric, but disparities persisted for minority races. Future studies may better classify the mediators of this association.

Type of study

Retrospective Cohort Study.

Level of Evidence

Level IV: Evidence from well-designed case–control or cohort studies.