Login to Access Video or Poster Abstract: MP66-07
Sources of Funding: Dalhousie Clinical Scholar Award

Introduction

Testicular torsion (TT) in minors is afflicted by delays in treatment due to inappropriate referrals to tertiary pediatric centers. We sought to determine whether point-of-care (community hospitals vs. tertiary centers) or other treatment delaying variables such as transfer, emergency room (ER) wait times and distance travelled affect testicular salvage rates in minors with TT using a National database.

Methods

Data prospectively collected by the Canadian Institute of Health Information (CIHI) between January 2010-December 2014 were obtained; all Canadian males <18 years of age with TT based on ICD codes were included, except for the province of Quebec. Variables collected were: age, complexity level of surgical center based on case mix (community small/medium, community large, or tertiary/academic), if patient was transferred for definitive treatment, road distance travelled to the point-of-care based on postal codes, ER wait time in hours. Outcome was testicular salvage based on intervention codes used by CIHI for orchiectomy/orchidopexy. Uni and multivariate analyses were performed using logistic regression.

Results

Complete data were available for 1736 out of 1935 TT patients <18 years of age. Overall testicular salvage rate was 70%. Most patients (52%) were treated at tertiary hospitals. On univariate analysis, there was no difference in testicular salvage rates between tertiary and large community hospitals (70% vs 66%); treatment at small/medium community hospitals was associated with higher salvage rates (77%) compared to large community ones (OR=0.59, CI 0.39-0.85, p<0.05). ER wait time longer than 1 hour was associated with a significant increase in testicular loss (OR=1.89, CI 1.41-2.52, p<0.0001). Transfer and distance travelled were not associated with higher orchiectomy rates, even on stratified analysis by type of hospital. On multivariate analysis, age 12-17 years, treatment at community small/medium or tertiary/academic hospitals and shorter ER wait times were significantly associated with higher salvage rates.

Conclusions

Point-of-care affects testicular salvage rates in minors with TT. Small/medium community hospitals depict the lowest orchiectomy rates; while academic centers had better outcomes than large community hospitals on multivariate analysis, it is unclear if this of clinical significance. Transfer to another facility for definitive care and distance travelled did not affect orchiectomy rates. Longer ER wait time and younger age were the most consistent risk factors associated with orchiectomy.

Funding

Dalhousie Clinical Scholar Award