S. S. Satahoo1, H. Hua1, J. E. Sola1, H. L. Neville1 1University Of Miami,Surgery,Miami, FL, USA
Introduction: Ovarian and testicular torsion are emergencies requiring prompt surgical treatment to preserve gonadal function. However, diagnosis in females is often delayed due to non-specific symptoms. We sought to assess disparities in management and outcomes between males and females with torsion, and evaluate the effect of race and insurance status.
Methods: The National Inpatient Sample was queried for pediatric patients with “emergent”, “urgent” or “trauma center” admission and ICD-9 codes for ovarian torsion and testicular torsion. Demographic data, operative repair, gonadal loss, length of stay (LOS), total charges (TC), and mortality were recorded. Student’s t-test, Χ2 test, and logistic regression were performed, where appropriate. Propensity score matching (PSM) using nearest neighbor 1:1 matching was implemented to further evaluate endpoints. A p-value <0.05 was considered significant.
Results:There were 2254 unweighted encounters. There were no mortalities in the cohort. Forty-eight percent were females. The average age for males was 11.6 ± 5.3 years and 12.6 ± 3.7 years for females (p<0.001). Among males, 90% underwent surgery (p<0.001), of which 40% required orchiectomy. Conversely, 73% of females had surgery (p<0.001), of which 78% had oophorectomy. Insurance status (p=0.012), race (p<0.001), hospital control (p=0.007), hospital location/teaching status (p=0.006), and hospital region (p<0.001) were significant and used for PSM, with age. Hospital bed size and calendar year were not significant. Females had longer LOS (2.4 ± 1.8 days vs. males 1.3 ± 2.2 days, p<0.001) with higher TC ($20,006.44 ± 13,500.45 vs. males $12,506.83 ± 12,586.50, p<0.001). After PSM, two gender cohorts of 1026 encounters each were obtained. For males, 90% had surgical repair (p<0.001), of which 37% had orchiectomy. Only 74% of females underwent surgery (p<0.001), of which 78% had oophorectomy. Females had longer LOS (2.4 ± 1.8 days vs. 1.2 ± 2.2 days for males, p<0.001) and had higher TC ($20,058.44 ± 13,420.82 vs. males $12,309.84 ± 12,377.18, p<0.001). Logistic regression revealed that males (Odds Ratio, OR 0.153 [0.114-0.206]) and older patients (age OR 0.944 [0.916-0.973]) were less likely to undergo gonadal loss. Compared to self pay patients, those with Medicare/Medicaid were more likely to have gonadal loss (2.169 [1.126-4.179]). Race was not significant (p=0.374).
Conclusion:Disparities exist in the management of torsion, primarily based on gender. Females were overall less likely to undergo surgery and when they did, they were more likely to have gonadal loss. Females also had higher charges and longer hospitalizations, which could be reflective of the invasive nature of surgery. In addition,public insurance and age are associated with increased gonadal loss.