Straight to the Operating Room: An Emergent Surgery Track for Acute Testicular Torsion Transfers

Michelle K. Arevalo, Kunj R. Sheth, Vani S. Menon, Lauren Ostrov, Halim Hennes, Nirmish Singla, Korgun Koral, Bruce J. Schlomer, Linda A. Baker

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective To assess the effect of implementing an emergency surgery track for testicular torsion transfers. We hypothesized that transferring children from other facilities diagnosed with torsion straight to the operating room (STOR) would decrease ischemia time, lower costs, and reduce testicular loss. Study design Demographics, arrival to incision time, hospital cost in dollars, and testicular outcome (determined by testicular ultrasound) at follow-up were retrospectively compared in all patients transferred to our tertiary care children's hospital with a diagnosis of testicular torsion from 2012 to 2016. Clinical data for STOR and non-STOR patients were compared by Wilcoxon rank-sum, 2-tailed t test, or Fisher exact test as appropriate. Results Sixty-eight patients met inclusion criteria: 35 STOR and 33 non-STOR. Children taken STOR had a shorter median arrival to incision time (STOR: 54 minutes vs non-STOR: 94 minutes, P <.0001) and lower median total hospital costs (STOR: $3882 vs non-STOR: $4419, P <.0001). However, only 46.8% of STOR patients and 48.4% of non-STOR patients achieved surgery within 6 hours of symptom onset. Testicular salvage rates in STOR and non-STOR patients were not significantly different (STOR: 68.4% vs non-STOR: 36.8%, P =.1), but follow-up was poor. Conclusions STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.

Original languageEnglish (US)
Pages (from-to)178-183
Number of pages6
JournalJournal of Pediatrics
Volume192
DOIs
StatePublished - Jan 1 2018

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Spermatic Cord Torsion
Operating Rooms
Hospital Costs
Ischemia

Keywords

  • operating room
  • pediatric hospitals
  • spermatic cord torsion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Straight to the Operating Room : An Emergent Surgery Track for Acute Testicular Torsion Transfers. / Arevalo, Michelle K.; Sheth, Kunj R.; Menon, Vani S.; Ostrov, Lauren; Hennes, Halim; Singla, Nirmish; Koral, Korgun; Schlomer, Bruce J.; Baker, Linda A.

In: Journal of Pediatrics, Vol. 192, 01.01.2018, p. 178-183.

Research output: Contribution to journalArticle

Arevalo, Michelle K. ; Sheth, Kunj R. ; Menon, Vani S. ; Ostrov, Lauren ; Hennes, Halim ; Singla, Nirmish ; Koral, Korgun ; Schlomer, Bruce J. ; Baker, Linda A. / Straight to the Operating Room : An Emergent Surgery Track for Acute Testicular Torsion Transfers. In: Journal of Pediatrics. 2018 ; Vol. 192. pp. 178-183.
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abstract = "Objective To assess the effect of implementing an emergency surgery track for testicular torsion transfers. We hypothesized that transferring children from other facilities diagnosed with torsion straight to the operating room (STOR) would decrease ischemia time, lower costs, and reduce testicular loss. Study design Demographics, arrival to incision time, hospital cost in dollars, and testicular outcome (determined by testicular ultrasound) at follow-up were retrospectively compared in all patients transferred to our tertiary care children's hospital with a diagnosis of testicular torsion from 2012 to 2016. Clinical data for STOR and non-STOR patients were compared by Wilcoxon rank-sum, 2-tailed t test, or Fisher exact test as appropriate. Results Sixty-eight patients met inclusion criteria: 35 STOR and 33 non-STOR. Children taken STOR had a shorter median arrival to incision time (STOR: 54 minutes vs non-STOR: 94 minutes, P <.0001) and lower median total hospital costs (STOR: $3882 vs non-STOR: $4419, P <.0001). However, only 46.8{\%} of STOR patients and 48.4{\%} of non-STOR patients achieved surgery within 6 hours of symptom onset. Testicular salvage rates in STOR and non-STOR patients were not significantly different (STOR: 68.4{\%} vs non-STOR: 36.8{\%}, P =.1), but follow-up was poor. Conclusions STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.",
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N2 - Objective To assess the effect of implementing an emergency surgery track for testicular torsion transfers. We hypothesized that transferring children from other facilities diagnosed with torsion straight to the operating room (STOR) would decrease ischemia time, lower costs, and reduce testicular loss. Study design Demographics, arrival to incision time, hospital cost in dollars, and testicular outcome (determined by testicular ultrasound) at follow-up were retrospectively compared in all patients transferred to our tertiary care children's hospital with a diagnosis of testicular torsion from 2012 to 2016. Clinical data for STOR and non-STOR patients were compared by Wilcoxon rank-sum, 2-tailed t test, or Fisher exact test as appropriate. Results Sixty-eight patients met inclusion criteria: 35 STOR and 33 non-STOR. Children taken STOR had a shorter median arrival to incision time (STOR: 54 minutes vs non-STOR: 94 minutes, P <.0001) and lower median total hospital costs (STOR: $3882 vs non-STOR: $4419, P <.0001). However, only 46.8% of STOR patients and 48.4% of non-STOR patients achieved surgery within 6 hours of symptom onset. Testicular salvage rates in STOR and non-STOR patients were not significantly different (STOR: 68.4% vs non-STOR: 36.8%, P =.1), but follow-up was poor. Conclusions STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.

AB - Objective To assess the effect of implementing an emergency surgery track for testicular torsion transfers. We hypothesized that transferring children from other facilities diagnosed with torsion straight to the operating room (STOR) would decrease ischemia time, lower costs, and reduce testicular loss. Study design Demographics, arrival to incision time, hospital cost in dollars, and testicular outcome (determined by testicular ultrasound) at follow-up were retrospectively compared in all patients transferred to our tertiary care children's hospital with a diagnosis of testicular torsion from 2012 to 2016. Clinical data for STOR and non-STOR patients were compared by Wilcoxon rank-sum, 2-tailed t test, or Fisher exact test as appropriate. Results Sixty-eight patients met inclusion criteria: 35 STOR and 33 non-STOR. Children taken STOR had a shorter median arrival to incision time (STOR: 54 minutes vs non-STOR: 94 minutes, P <.0001) and lower median total hospital costs (STOR: $3882 vs non-STOR: $4419, P <.0001). However, only 46.8% of STOR patients and 48.4% of non-STOR patients achieved surgery within 6 hours of symptom onset. Testicular salvage rates in STOR and non-STOR patients were not significantly different (STOR: 68.4% vs non-STOR: 36.8%, P =.1), but follow-up was poor. Conclusions STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.

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