O2156: Sex-based Disparities in the Management of Pediatric Gonadal Torsion

Background: Gonadal torsion is a surgical emergency and delays in care can result in gonadal ischemia and necrosis that can impact future fertility. In June 2015, the U.S. News and World Report (USNWR) “Best Children’s Hospitals” ranking implemented a quality metric awarding hospitals that expedited surgical care of children and adolescents with suspected testicular torsion. Nationally, this led to a decrease in time to the OR and increased rates of testicular salvage. However, unified national quality improvement metrics for ovarian torsion are lacking. This study examined trends in time from hospital presentation to operative intervention among children and adolescents with suspected gonadal torsion before and after implementation of the 2015 USNWR quality metric for testicular torsion.

Methods: A single center retrospective cohort study was performed, identifying pediatric patients (1-18 years of age) between 2011-2019 who underwent surgery with a preoperative suspicion of gonadal torsion. The primary outcome was time from hospital presentation to surgery start time (time to OR). An interrupted time series analysis was performed to identify changes in time to OR. June 2015 used as the intervention time point. Wilcoxon rank-sum and chi-square tests were used for bivariate analysis.

Results: Of 336 patients with suspected gonadal torsion, 216 presented with suspected testicular torsion (TT) and 120 patients with suspected ovarian torsion (OT). The median age of both cohorts was 13 years (IQR: TT 9–15, OT 11–15) and baseline clinical characteristics were similar pre- vs post-quality metric implementation. The primary presenting symptoms in the TT group were testicular pain (88%) and scrotal swelling (20%) with median time to OR of 147 minutes (IQR: 99–198). The OT group presented most commonly with abdominal pain (97%) and nausea/vomiting (68%) with median time to OR of 462 minutes (IQR: 308–606). After implementation of the USNWR quality metric for testicular torsion in June 2015, the TT group saw a significant decrease in mean time to OR by 33 minutes (-56 – -10; p=0.03), while the OT group did not observe a significant decrease in time to OR (p=0.14). Subgroup analysis of the OT group showed that patients with a history of a known ovarian mass (N=62) experienced a shorter time to OR compared to those without a previously known ovarian mass (422 vs 499 minutes; p=0.04), but this did not change significantly post-quality metric implementation (p=0.33).

Conclusion: Since implementation of a national quality metric for testicular torsion, children and adolescents with suspected testicular torsion experienced a significant decrease in time to OR. In contrast, children and adolescents presenting with suspected ovarian torsion did not experience an improvement in time to OR. These findings highlight the need for equitable unified quality metrics for children and adolescents presenting with suspected gonadal torsion.