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Inequities and Progress in Testicular Torsion Care Following a US News & World Report Metric: A Retrospective Cohort
Ahmed Souid1, Maithili Gopalakrishnan2, Michael Basin2
1Department of Pediatrics, SUNY Upstate Medical University, 750 E Adams St, Syracuse, NY, USA.
Insights
Pediatric testicular torsion salvage rates improved in hospitals complying with a US News metric, especially for patients with economic or communication barriers. However, racial disparities in testicular torsion treatment persisted.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Socioeconomic Disparities
Background:
- Pediatric testicular torsion is a time-sensitive surgical emergency.
- Existing health disparities impact treatment outcomes.
- The US News and World Report's (USNWR) Speed in Treating Testicular Torsion (SiTTT) metric was introduced to incentivize timely care.
Purpose of the Study:
- To evaluate the impact of the USNWR SiTTT metric on testicular salvage rates in pediatric patients.
- To determine if the SiTTT metric mitigated existing health inequities in the treatment of testicular torsion.
Main Methods:
- Retrospective cohort study using the Pediatric Health Information System database (2010-2019).
- Hospitals classified as complete-scoring or partial-scoring based on SiTTT metric compliance in 2015.
- Surgical testicular salvage defined as orchiopexy without orchiectomy.
- Analysis of salvage rates based on socioeconomic factors, including race, comparing pre- and post-metric periods.
Main Results:
- Overall, 3950 cases of pediatric testicular torsion were analyzed.
- Only partial-scoring hospitals showed a significant improvement in testicular salvage rates post-metric (61.0% to 67.5%).
- Patients with economic or communicative barriers experienced the most significant improvement in salvage rates (35.3% to 61.1%).
- No statistically significant improvement in salvage rates was observed for minority races; the disparity gap widened.
Conclusions:
- Compliance with the USNWR SiTTT metric improved equity for patients with economic or communicative barriers.
- Significant racial disparities in testicular torsion treatment and outcomes persist despite the metric.
- Further research is needed to identify and address the mediators of these persistent disparities.
Background And Objectives:
Pediatric testicular torsion is a surgical emergency with known health disparities. The US News and World Report is an American media company that ranks colleges and hospitals based on annually published criteria. Hospitals that complied with the US News and World Report's (USNWR) Speed in Treating Testicular Torsion (SiTTT) metric saw improved surgical testicular salvage rates, but the metric's impact in mitigating inequities in testicular torsion is unstudied.
Methods:
A retrospective cohort study of patients 1-18 years of age presenting with testicular torsion was performed using the Pediatric Health Information System database. Hospitals were classified based on their SiTTT score at the metric's onset in 2015: they were labeled complete-scoring if they achieved the maximum score and partial-scoring otherwise. Surgical testicular salvage was defined as orchiopexy without concomitant orchiectomy. Testicular salvage rates were compared based on various socioeconomic variables including race between the pre-metric (2010-2015) and post-metric (2015-2019) periods with both univariate and adjusted, multivariate analyses.
Results:
We identified 3950 cases of testicular torsion: 2335 in complete-scoring hospitals and 1615 in partial-scoring hospitals. Only partial-scoring hospitals improved significantly in salvage rate (pre-metric 61.0 % vs post-metric 67.5 %, p < 0.01). Subgroup analysis revealed the largest benefit in patients with economic or communicative barriers such as those with complex chronic conditions (pre-metric 35.3 % vs post-metric 61.1 %, p < 0.05). No minority races had statistically significant improvement after the metric, and salvage rate gap between White and all other races increased (pre-metric 4.3 % vs post-metric 10.0 %, p < 0.05).
Conclusions:
Patients with communicative or economic barriers showed improved equity after efforts to comply with a third-party metric, but disparities persisted for minority races. Future studies may better classify the mediators of this association.
Type Of Study:
Retrospective Cohort Study.
Level Of Evidence:
Level IV: Evidence from well-designed case-control or cohort studies.
