O. A. Morin1, M. G. Carr1, S. D. Bhattacharya1 1University of Tennessee Chattanooga,General Surgery,Chattanooga, TN, USA
Introduction: Little published evidence has been presented that drastically minimizing the “time-to-treat” in testicular torsion results in fewer orchiectomies. However, the current ACS NSQIP benchmark is a time-to-treat <2h. Duration of symptoms (DoS) may serve as a more accurate predictor. We evaluated testicular salvage rates based on patient presentation with <24h versus >24h total DoS. We hypothesize that time-to-treat has little impact on testicular salvage rates and patients’ DoS better correlates with predicting testicular viability.
Methods: Medical records of all male pediatric patients treated for suspected diagnosis of testicular torsion in the emergency department from January 1, 2016 to September 30, 2017 were retrospectively evaluated. Twenty-three patients met inclusion criteria. Statistical analysis compared testicular viability based on both time-to-treat, DoS, and patients originating in our system versus transfers from outside hospitals.
Results:
Testicular salvage rates for patients presenting directly to the ED was 50% with an average time-to-treat of 2.6h. Testicular salvage rates in patients transferred from an outside ED was 88.9% with an average time-to-treat of 5.1h. Overall testicular survival was not statistically impacted by decreasing the time-to-treat by an average of 3h (p<0.189).
When comparing DoS, a 77.8% testicular salvage rate (DoS <24 hours) versus a 16% salvage rate (DoS >24 hours) was shown in patients presenting directly to the ED (p<0.041). Within the total population (N=23), a significant difference was shown (p<0.023) when comparing overall testicular salvage rates in patients presenting with <24h versus >24h total DoS.
Conclusion: In this case series, it appears that a better predictor of ultimate outcomes and increased testicular salvage rates is a duration of symptoms <24h rather than a shortened time-to-treat. This is a meaningful metric when providing accurate pre-operative counselling to parents and may better focus quality improvement efforts surrounding this topic.
