Factors Associated With Pediatric Testicular Torsion Leading to Orchiectomy

INTRODUCTION: Testicular torsion is a surgical emergency that can require an orchiectomy. The purpose of the study was to identify factors associated with testicular torsion that result in an orchiectomy.

METHODS: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2020-2023) was queried for patients aged 6 to 18 y who underwent an orchiectomy or orchiopexy for testicular torsion. Patient demographics, surgery type, and 30-day outcomes were compared, and a logistic regression model was fit to identify factors related to a patient undergoing an orchiectomy.

RESULTS: Of the 4026 patients included, 6.3% (252) underwent orchiectomy and 93.7% (3774) underwent orchiopexy. Independent factors associated with an increased odds for orchiectomy were impaired cognitive status/developmental delay (odds ratio; 95% confidence interval) (3.6; 2.2-5.9) and race (P = 0.0005). Compared to White race, Black race increased odds by 2.0 (1.4-2.8), other/unknown race by 1.5 (1.1-2.1), and Asian race by 1.6 (0.9-3.0). Other surgeon specialties (adult urologists and general pediatric surgeons) were associated with lowered odds to 0.5 (0.4-0.7) compared to pediatric urologists. No differences were found in 30-day reoperation or readmission rates.

CONCLUSIONS: Race, impaired cognitive status/developmental delay, and surgeon specialty were associated with high odds of undergoing an orchiectomy in pediatric patients with torsion. Further investigation is warranted to better understand these associations, including their impact on referral patterns that may lead to delays in diagnosis and treatment.