PD49-09 THE BALL's IN YOUR COURT: TRENDS, CAUSES, OUTCOMES, AND COSTS OF TRANSFER FOR PEDIATRIC TESTICULAR TORSION

You have accessJournal of UrologyPediatrics V (PD49) 1 May 2024PD49-09 THE BALL's IN YOUR COURT: TRENDS, CAUSES, OUTCOMES, AND COSTS OF TRANSFER FOR PEDIATRIC TESTICULAR TORSION Emily K. Clennon, Alexa Stefanko, Megan Guerre, J. Christopher Austin, and Casey A. Seideman Emily K. ClennonEmily K. Clennon, Alexa StefankoAlexa Stefanko, Megan GuerreMegan Guerre, J. Christopher AustinJ. Christopher Austin, and Casey A. SeidemanCasey A. Seideman View All Author Informationhttps: //doi. org/10. 1097/01. JU. 0001008752. 72292. d7. 09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The transfer of pediatric patients with testicular torsion from community hospitals to tertiary pediatric centers can be a time and resource-intensive step toward emergent surgical intervention. We sought to describe trends of patient transfer in our state and compare clinical outcomes and health system costs between patients transferred and treated primarily at a pediatric center. METHODS: This retrospective cohort study compared patients aged 1-18 who presented directly to a pediatric center to those transferred for acute testicular torsion from 2018-2023. Exclusion criteria included age <1 year, non-urgent surgery (intermittent torsion), and direct admission from clinic. Patient age, height, weight, Tanner stage, ASA class, insurance coverage, and presentation time were evaluated as covariates. Group characteristics and times from symptom onset to ED presentation to surgery were compared via two-sided Student's t-tests. Clinical outcomes (orchiectomy, testicular atrophy) were compared via Fisher's exact tests. Costs from transferring hospitals were estimated from costs at the pediatric center, and medical transport costs were extrapolated from contract prices between transport agencies and the pediatric center to compare total episode-of-care cost between groups. RESULTS: A total of 133 cases (37 primaries, 96 transfers) met inclusion criteria. Transfers increased over the study period (67% to 75%). There were no significant differences in age, Tanner stage, ASA score, BMI, or presentation time between groups. Median transfer distance was 12 miles (IQR 7-22) and time was 1 hour (IQR 1-2). More than half of cases (53%) were transferred due to hospital policy regarding surgical treatment of minors, and 25% due to lack of urology coverage. Time from ED to OR was nearly doubled for the transfer group (median 4. 5 vs 2. 5 hours, p=0. 02). Despite a higher rate of orchiectomy in the primary group (43 vs 22%, p=0. 01), this difference was not significant after stratification by symptom duration. There was no significant difference in testicular atrophy (27% primary vs 19% transfer, p=0. 52). The estimated average cost of care for patients transferred was approximately twice that of patients treated primarily (14, 935 vs 7, 956). CONCLUSIONS: Transfer of pediatric patients in our state for testicular torsion has increased in recent years. Patient transfer nearly doubled time to surgical intervention and cost of care. Hospital policies and local urology coverage are primary drivers of transfer and represent opportunities for health system improvement. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc. FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1053 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc. Metrics Author Information Emily K. Clennon More articles by this author Alexa Stefanko More articles by this author Megan Guerre More articles by this author J. Christopher Austin More articles by this author Casey A. Seideman More articles by this author Expand All Advertisement PDF downloadLoading. . .