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

Area of Science:

• Pediatric Surgery
• Urology
• Emergency Medicine

Background:

• Testicular torsion is a surgical emergency requiring prompt intervention to preserve testicular function.
• Delays in diagnosis and treatment can lead to testicular ischemia and loss.
• Optimizing transfer protocols for pediatric patients with testicular torsion is crucial.

Purpose of the Study:

• To evaluate the impact of an emergency surgery track for testicular torsion transfers on ischemia time, hospital costs, and testicular outcomes.
• To determine if direct transfer to the operating room (STOR) improves patient outcomes compared to standard transfer protocols.

Main Methods:

• Retrospective comparison of 68 pediatric patients with testicular torsion transferred to a tertiary care center between 2012 and 2016.
• Data analyzed included demographics, arrival-to-incision time, hospital costs, and testicular outcomes.
• Patients were divided into two groups: those undergoing direct transfer to the operating room (STOR) and those following non-STOR protocols.

Main Results:

• The STOR group experienced significantly shorter median arrival-to-incision times (54 minutes vs. 94 minutes) and lower median hospital costs ($3882 vs. $4419).
• Testicular salvage rates were not significantly different between the STOR (68.4%) and non-STOR (36.8%) groups.
• A substantial proportion of patients in both groups did not undergo surgery within 6 hours of symptom onset, and follow-up was limited.

Conclusions:

• The emergency surgery track (STOR) effectively reduced intra-hospital delays and costs for testicular torsion transfers.
• The primary contributors to ischemia time appear to be delays occurring before patient arrival at the tertiary care center.
• Further interventions targeting pre-transfer diagnosis and transport are necessary to enhance testicular salvage rates in torsion transfer cases.