Pd05-02 Disparities After Time-to-or Improvements in Testicular Torsion May Guide Future Quality Improvement

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes I (PD05)1 May 2024PD05-02 DISPARITIES AFTER TIME-TO-OR IMPROVEMENTS IN TESTICULAR TORSION MAY GUIDE FUTURE QUALITY IMPROVEMENT Ahmed Souid, Michael Basin, Brian Chun, Glenn Cannon, Matthew Mason, Anthony Tracey, and Jeffrey Villanueva Ahmed SouidAhmed Souid , Michael BasinMichael Basin , Brian ChunBrian Chun , Glenn CannonGlenn Cannon , Matthew MasonMatthew Mason , Anthony TraceyAnthony Tracey , and Jeffrey VillanuevaJeffrey Villanueva View All Author Informationhttps://doi.org/10.1097/01.JU.0001008624.07191.ab.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social drivers of health have consequences on care outcomes. Delayed time to exploration is the primary reason for failed testicular salvage. In 2015, the US News and World Report (USNWR) included a Speed in Treating Testicular Torsion metric in its ranking of children's hospitals. Hospitals with partial scoring on this metric were incentivized to change practice patterns to achieve a complete score. A complete score required 90% of testicular torsion cases be explored within 4 hours. Subgroups that did not benefit from improved time-to-OR likely have significant out-of-hospital delay. METHODS: The Pediatric Health Information System was queried to identify cases of testicular torsion based on ICD and CPT codes across 52 hospitals between Jan. 2010 and Dec. 2019 in patients 1-18 years of age. Any case with orchiectomy was considered a failed testicular salvage. Salvage surgery rates before and after the publication of the USNWR metric on June 15, 2015 were compared for statistical significance with chi squared analysis. RESULTS: We identified 1,615 cases of pediatric torsion in initially partial-scoring hospitals. As hospitals with a partial-score transitioned to full-scoring, their testicular salvage rates improved (61.0% vs 67.5%, p<0.01). But, improvements were not uniformly observed in all subgroups: Improvements after the metric were largest in patients with communicative barriers to care such as those with a complex chronic condition (35.3% vs 61.1%, p<0.05) or in the youngest age group (44.7% vs 55.5%, p<0.05). There were also improvements in patients with socioeconomic barriers such as low Child Opportunity Index (56.0% vs 65.4%, p<0.01) and income in the lowest quartile (51.2% vs 75.0%, p<0.05). Subgroups that did not improve with reduced time-to-the-OR include patients living twenty-five miles or more from the hospital (51.5% vs 58.3%, p=0.19) and those belonging to a minority race Table 1. CONCLUSIONS: Reducing the time from the emergency department to the operating room improved salvage rates in many subgroups with social drivers of health. Patients that did not improve likely have delayed presentation to the hospital. Living far from the hospital is a natural cause for this, but we observe the same trend for minority races. Their delay may be due to medical mistrust, health stigma, and racism. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e89 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Ahmed Souid More articles by this author Michael Basin More articles by this author Brian Chun More articles by this author Glenn Cannon More articles by this author Matthew Mason More articles by this author Anthony Tracey More articles by this author Jeffrey Villanueva More articles by this author Expand All Advertisement PDF downloadLoading ...