Straight to the Operating Room: An Emergent Surgery Track for Acute Testicular Torsion Transfers

Abstract

STOR decreased arrival to incision time and hospital cost but did not affect testicular loss. The bulk of ischemia time in torsion transfers occurred before arrival at our tertiary care center. Further interventions addressing delays in diagnosis and transfer are needed to truly improve testicular salvage rates in these patients.

Pediatric testicular torsion: does patient transfer affect time to intervention or surgical outcomes at a rural tertiary care center?

“…Other studies have recognized the importance of shorter times from arrival to the operating rooms in patients who have already experienced delays in management due to the need for hospital transfer. One study implemented a standardized track called “Straight to the Operating Room” with a goal of reducing time to surgery, decreased hospitalization costs, and less overall testicular loss [14]. While they did not see a statistically significant reduction in testicular loss, the STOR track did significantly decrease time to surgery and hospitalization cost for affected patients [14].…”

“…One study implemented a standardized track called “Straight to the Operating Room” with a goal of reducing time to surgery, decreased hospitalization costs, and less overall testicular loss [14]. While they did not see a statistically significant reduction in testicular loss, the STOR track did significantly decrease time to surgery and hospitalization cost for affected patients [14]. Additionally, the distance that patients had to travel was not statistically correlated with amount of delay.…”

“…Delayed intervention can result in permanent ischemic injury of the testis that can lead to long term consequences including testicular loss and infertility [8–10]. Irreversible ischemia from torsion begins in 6 h from symptom onset and the likelihood of testicular salvage is the highest within the first 6 hours [7, 11]. Based on prior literature, treatment with 6 h of symptom onset correlates with 90–100% chance of testicular salvage [12].…”

“…If surgery is delayed more than 24 h following symptom onset, testicular non-viability is almost inevitable even if the testicular tissue appears viable during surgical exploration [13]. Due to factors such as patient preference, hospital capacity, and access to health care providers capable of managing TT, over 1/3rd of patients with suspected TT are transferred to a tertiary care facility for management, which increases total time of ischemic damage and morbidity [11].…”

Access to emergency paediatric surgery for testicular torsion or intestinal volvulus in New Zealand: A system perspective

“…21 Some institutes have introduced novel care pathways that streamline (or bypass altogether) the emergency presentation directing transfer directly to the operating suite. 22,23 Time to presentation contributes more significantly to testicular ischaemic time than 'in-hospital' time. 20 A delay in accessing medical care may relate to the young persons': own reluctance to share their symptoms with their parents; sensitivities related to the location of pathology, particular when pubertal; reliance on their parents for all aspects of healthcare, knowledge of testicular pathologies, experience of health education and testicular health specifically, views and experiences of health issues; health information-seeking behaviour, and ability to discuss male issues with their parents.…”