Factors influencing timely management and outcomes in testicular torsion

Testicular torsion (TT) is a surgical emergency in which prompt intervention is critical for testicular salvage. Delays in care remain common and may occur both before and after hospital presentation.

To identify clinical and non-clinical predictors of orchiectomy in patients with TT and determine whether pre-hospital or in-hospital delays have the greater impact on testicular salvage.

We retrospectively reviewed all TT cases from 2017 to 2024 at a metropolitan tertiary care center. Demographic and process variables were collected, including time intervals throughout emergency and operative management. Univariate and multivariate logistic regression were used to identify predictors of orchiectomy, and a logistic regression spline model was constructed to characterize the relationship between time to presentation and orchiectomy risk.

Among 109 patients, 34 % underwent orchiectomy. On multivariate analysis, only pre-hospital symptom duration predicted orchiectomy: 6-24 h (OR 11.7, 95 % CI 2.1-94.0, p = 0.009) and >24 h (OR 430.7, 95 % CI 21.9-21031.6, p < 0.001). The spline model estimated a 50 % probability of orchiectomy at approximately 23 h after symptom onset. Weekend or nighttime admissions, hospital transfer, and triage-to-OR time were not associated with orchiectomy. Median in-hospital time from ED triage to OR start was 4.1 h (IQR 3.2-4.8) and there was no significant differences between orchiopexy and orchiectomy groups (p = 0.068).

Pre-hospital delay was the primary driver of orchiectomy risk, whereas in-hospital workflow factors had no statistically significant impact on outcomes. While continued efforts to optimize triage efficiency for patients with suspected TT remain important, our findings suggest that educational initiatives promoting early symptom recognition and prompt emergency department presentation may offer greater potential for improving testicular salvage than further in-hospital process refinements.

Although streamlining in-hospital triage for patients with suspected TT remains important, targeting pre-hospital delays through patient, parental, and provider education may offer even greater opportunities to improve testicular salvage.