The impact of sociodemographic factors and patient transfer on hospital throughput and surgical outcome in acute testicular torsion.

Abstract

Introduction: Timely diagnosis and management of acute testicular torsion (ATT) is a benchmark for quality of care. We sought to evaluate whether patient sociodemographic factors and transfer status had an impact on hospital throughput and orchiectomy in ATT patients.

Methods: From 1/1/2022 to 9/9/2023, patients were identified by CPT code for operations to treat ATT and confirmed by chart review. Patient demographics were noted, and socioeconomic status (SES) was estimated using a distress score produced via the Distressed Communities Index (DCI), a multidimensional measure of social context. We denoted patients who were transferred to our urban tertiary care children's hospital and tracked emergency department (ED) registration time, time of arrival in the operating room (OR), and whether a repeat scrotal ultrasound (SUS) was performed for transfer patients. Based on a quality improvement measurement framework, the time between ED and OR (i.e., hospital throughput) served as our process measure, and orchiectomy rate was our outcome measure.

Results: 100 patients were diagnosed with ATT at a median age of 14 years (IQR 12-15). Median time from ED to OR was 110 min (IQR 79-144). Sixty-one patients were transferred to our institution, and this cohort reflected a higher proportion of White, non-Hispanic patients (p = 0.04) with a lower median distress score (14.4 vs 36.8, p = 0.03). Obtaining a repeat SUS in 25 transfer patients (41 %) prolonged the time to OR by a median of 20 min (p < 0.01). Regardless of repeat SUS, transfer patients had faster hospital throughput than those patients who presented primarily to our institution (p < 0.01). Overall, the orchiectomy rate was 18 %, and this outcome was associated with younger patient age (p < 0.01) and longer reported duration of symptoms (p < 0.01).

Discussion: Transfer patients had a higher SES and experienced faster hospital throughput than patients presenting primarily to our institution. Repeating SUS in transfer patients added modestly to the time to OR but did not impact the likelihood of orchiectomy. In fact, neither transfer status nor sociodemographic factors, other than patient age, were associated with orchiectomy. Further research is needed to identify factors that affect testicular viability and what efforts might improve surgical outcomes.

Conclusions: Patients with ATT transferred to our institution after presenting to a local hospital experienced prompt management with quicker time from ED to OR, though this did not impact their surgical outcome. Only younger patient age and longer reported duration of symptoms increased the likelihood of orchiectomy.