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Salvage Surgery Rates for Pediatric Testicular Torsion: Comparison of the Pre- and Post-Quality Metric Eras
Brian Chun1, Marc Colaco1, Janelle A Fox1
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
National quality metrics improved pediatric testicular torsion outcomes. Testicular salvage surgery rates increased by 12.5% after metric implementation, showing a significant positive impact on this urological emergency.
Area of Science:
- Pediatric Urology
- Surgical Outcomes Research
- Healthcare Quality Improvement
Background:
- Pediatric testicular torsion is a critical urological emergency requiring prompt treatment.
- National quality metrics for testicular torsion were introduced in 2015 by U.S. News & World Report.
- Assessing the impact of these metrics on surgical outcomes is crucial.
Purpose of the Study:
- To compare testicular salvage surgery rates before and after the implementation of national quality metrics.
- To evaluate the effectiveness of quality metrics in improving outcomes for pediatric testicular torsion.
- To analyze multi-institutional data on testicular torsion treatment.
Main Methods:
- Utilized the Pediatric Health Information System® database from January 2010 to December 2019.
- Included 52 hospitals, focusing on patients aged 1 to 17 years undergoing testicular torsion treatment.
- Defined testicular salvage surgery as orchiopexy without orchiectomy; compared pre- and post-metric cohorts.
Main Results:
- A total of 890 patients from 38 hospitals were analyzed (551 pre-metric, 339 post-metric).
- Testicular salvage surgery rates increased by 12.5% post-metrics (70.9% vs. 58.4%).
- Hospital compliance with quality metrics rose from 62% (2015) to 98% (2019).
Conclusions:
- Implementation of quality metrics led to a significant increase in testicular salvage rates for pediatric torsion.
- Patient demographics and clinical factors did not differ significantly between the two cohorts.
- Further prospective multi-institutional studies are recommended to validate these findings and assess overall salvage rates.
Purpose:
Pediatric testicular torsion is a urological emergency that requires timely intervention. In 2015, quality metrics for testicular torsion were implemented in the U.S. News & World Report "Best Children's Hospitals" rankings. Our study examines and compares testicular salvage surgery rates before and after the institution of national quality metrics from a multi-institutional database.
Materials And Methods:
The Pediatric Health Information System® was surveyed for all testicular torsion encounters using ICD (International Classification of Diseases), Ninth and Tenth Revisions coding from 52 hospitals between January 2010 and December 2019. Patients <1 year and ≥18 years of age were excluded. Only hospitals that reported outcomes before and after quality scoring were included. Testicular salvage surgery was defined as patients having undergone orchiopexy without concomitant orchiectomy. Age, race, distance from hospital, household income and insurance status were compared.
Results:
A total of 890 patients (551 pre-metric and 339 post-metric) from 38 hospitals were included. The testicular salvage surgery rate was 12.5% higher in the post-metric cohort (70.9% versus 58.4%). Hospital compliance to testicular torsion quality metrics increased from 62% in 2015 to 98% in 2019. Mean age, race, distance to hospital, household income, insurance status and use of ultrasound were not statistically different between pre- and post-metric cohorts.
Conclusions:
Since the implementation of quality metrics, salvage surgery rates for testicular torsion increased to 70.9%, an improvement of 12.5% when compared to pre-metric outcomes. Patient factors were similar between the 2 groups. Multi-institutional prospective data are needed to validate this database study and evaluate overall testicular salvage rate.
