O4355: Trends in Testicular Torsion and Orchiectomies Before, During, and After the COVID-19 Pandemic

Background: The impact of COVID-19 on testicular torsion frequency, management, and outcomes remains underexplored. Our objectives were to assess testicular torsion and orchiectomy frequencies and associated risk factors before, during, and after the pandemic.

Methods: The Pediatric Health Information System (PHIS) database was queried to identify patients (aged 1 month to 18 years) with the diagnosis of testicular torsion (identified by ICD-10 codes N44.0 and N 44.1) who underwent surgical treatment (identified by CPT codes 54520, 54550, 54560, 54640, 54650, 54692, 54600, and 54620) between March 13, 2018 – June 30, 2024. We analyzed demographic data from these patient records, calculated frequencies of torsion and rates of orchiectomy and analyzed the data across three periods: pre-, during, and post-COVID-19.

Results: Testicular torsion frequency increased before and during the pandemic, plateauing post-pandemic. Frequency was highest in the 12–14 year age group, followed by those 12 years and under. Frequency was higher in non-Hispanic or Latino individuals than Hispanic or Latino individuals and in White individuals than non-White individuals.



Orchiectomy rates were highest in the 12-year-and-under group, decreasing from 30% pre-COVID-19 to 28% during COVID-19 and 27% post-COVID-19. Individuals with Medicare or self/other insurance consistently had higher orchiectomy rates than those with commercial insurance, with an increase in the self/other group during COVID-19 (34% vs. 23% pre-COVID-19 and 22% post-COVID-19). Non-White individuals had higher orchiectomy rates than White individuals across all periods, peaking pre-COVID-19 (28%) and declining during (26%) and post-COVID-19 (24%) (Figure 1).

Conclusion: These findings suggest that COVID-19 influenced testicular torsion presentation and resulting orchiectomy rates and highlight disparities in healthcare access, particularly by age, race, and insurance status. The trends in frequency of testicular torsion and orchiectomy rates underscore the need for further research into contributing factors and barriers to timely care.