O4356: Factors Associated with Pediatric Testicular Torsion Leading to Orchiectomy

Background: Testicular torsion is a surgical emergency that can require an orchiectomy, potentially impacting fertility of pediatric male patients. The purpose of the study is to identify factors associated with testicular torsion that results in orchiectomy.

Methods: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2020-2023) was queried for patients aged 6 to 18 years who underwent an orchiectomy or orchiopexy for testicular torsion. Patient demographics, surgery type, and 30-day outcomes were compared using descriptive statistics. Mann-Whitney U tests were used to compare continuous variables, chi-square or Fisher’s exact tests where appropriate were used to compare categorical variables. Logistic regression model was fit for predicting orchiectomy compared to orchiopexy.

Results: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2020-2023) was queried for patients aged 6 to 18 years who underwent an orchiectomy or orchiopexy for testicular torsion. Patient demographics, surgery type, and 30-day outcomes were compared using descriptive statistics. Mann-Whitney U tests were used to compare continuous variables, chi-square or Fisher’s exact tests where appropriate were used to compare categorical variables. Logistic regression model was fit for predicting orchiectomy compared to orchiopexy. Of cases performed by pediatric urologists, 7.1% were orchiectomies and 92.9% were orchiopexies, while cases performed by pediatric general surgeons and adult urologists 4.4% and 2.6% were orchiectomies compared to 95.6% and 97.4% were orchiopexies (p= 0.0008) (Table 2). The operative time for orchiectomy was slightly longer at a median of 43 minutes (IQR: 34.0- 60.0) compared to a median of 39 minutes (IQR: 30.0-50.0) (p < 0.0001) for orchiopexy. Independent patient factors associated with an increased odds for orchiectomy were impaired cognitive status ((Odds ratio; 95% confidence interval) (3.9; 2.4-6.3)) and race, where patients of black race (2.0; 1.4-2.7) and other/unknown race (1.5; 1.1-2.1) had higher odds compared to patients of white race but patients of Asian race (1.6; 0.9-2.9) did not have higher odds.

Conclusion: Race and developmental delay/impaired cognitive status are associated with increased odds for orchiectomy in pediatric patients with torsion. Pediatric urologists performed a greater proportion of cases compared to other surgical specialists within orchiectomy and orchiopexy cohorts. Further investigation is warranted to better understand these associations including their impact of referral patterns that may lead to delays in diagnosis and treatment.