Individual and systems level factors associated with odds of orchiectomy in testicular torsion in New York State.

INTRODUCTION: Testicular torsion is a urologic emergency that can result in loss of the affected testicle. Although many studies have investigated factors affecting the odds of orchiectomy versus orchiopexy, they are often limited by small sample sizes and lack age-stratified analyses. This study seeks to identify factors associated with orchiectomy associated with testicular torsion within different pediatric age groups in New York State over a 15-year period. MATERIAL AND METHODS: The Statewide Planning and Research Cooperative System (SPARCS) database was queried from 2003 to 18 for patients aged 1-18 years with testicular torsion (ICD-9608.2, ICD-10 N44.00) who underwent orchiectomy (CPT code 54,520) and orchiopexy (CPT codes 54,600, 54,620, 54,640, 54,650). Unadjusted and adjusted logistic regression models examined associations between orchiectomy and age, time and day of presentation, presentation to trauma center, insurance status and year. Patients were stratified into 3 age groups: 1-6 years, 7-12 years, and 13-18 years. RESULTS: A total of 4159 children were included. 26% underwent orchiectomy. In unadjusted models, the odds of orchiectomy were higher during peak hours (5am-5pm) (OR = 1.35, p = 0.001) and lower during the weekend (OR = 0.79, p = 0.033). Individuals with government insurance (compared to private or self-pay) had higher odds of orchiectomy (OR = 1.55, p < 0.0001). In stratified and adjusted models, correlates varied by age group. Among children ages 1-6 (N = 766), odds of orchiectomy were lower on the weekend (OR = 0.46, p = 0.034). Among children 7-12 (N = 915), there was no difference in time or day of presentation; however, they had increased odds of orchiectomy if they had government insurance (OR = 1.5, p = 0.03) or self-pay (OR = 3.31, p = 0.014), and if they presented to a trauma center (OR = 1.5, p = 0.037). Children 13-18 (N = 2478) had higher odds of orchiectomy if they presented later in the day (1.05 for every hour after midnight [p < 0.0001]) and if they had government insurance (OR = 1.27, p = 0.046). CONCLUSIONS: Predictors of orchiectomy vary substantially across different pediatric age groups, with distinct patterns related to time and day of presentation, insurance type, and presentation to a trauma center. These findings have implications for a healthcare systems approach to improving pediatric urological outcomes.