title: Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates.
abstract: OBJECTIVE
  While the timely diagnosis and management of pediatric torsion can lead to testicular salvage, limited data exist on rates of orchiopexy vs orchiectomy and associated factors. Thus, we examined the Pediatric Health Information System database for torsion outcomes and demographics at American pediatric hospitals.
  
  
  METHODS
  Using the Pediatric Health Information System database we performed a 7-year retrospective cohort study in children 1 to 17 years old with a primary ICD-9 diagnosis of torsion, assessing CPT codes for orchiopexy and orchiectomy. Data were analyzed with SPSS®, version 17.0.
  
  
  RESULTS
  Of 2,876 patients who underwent surgery for an ICD-9 diagnosis code of testicular torsion 918 (31.9%) underwent orchiectomy at a mean age of 10.7 years and 1,958 (68.1%) underwent orchiopexy at a mean age of 12.6 years (p <0.0001). In the age groups 1 to 9, 10 to 13 and 14 years or greater 274 (49.9%), 311 (29.4%) and 333 patients (26.2%), respectively, underwent orchiectomy. A higher orchiectomy rate was seen at age 1 to 9 vs 10 years or greater. Torsion and orchiectomy rates did not vary by season or geographic region. A higher orchiectomy rate was seen in black vs white children (37.6% vs 28.1%) and in patients without vs with private insurance (36.7% vs 27.0%). Multivariate analysis revealed an association of age (p <0.0001), race (p <0.0001) and insurance status (p <0.001) with orchiectomy.
  
  
  CONCLUSIONS
  Nationally an average of 32% of the 411 pediatric torsion cases explored annually result in orchiectomy. Identified factors increasing the orchiectomy risk included age 1 to 9 years, black race and lack of private insurance. Efforts should continue to identify modifiable variables that can increase testicular salvage in patients with testicular torsion.
authors.affiliation: Division of Pediatric Urology and Department of Research (RH), Children's Medical Center and University of Texas Southwestern Medical Center at Dallas, TX, USA. nicholas.cost@sbcglobal.net
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Cost
authors.forename: Nicol C
authors.initials: NC
authors.lastname: Bush
authors.forename: Theodore D
authors.initials: TD
authors.lastname: Barber
authors.forename: Rong
authors.initials: R
authors.lastname: Huang
authors.forename: Linda A
authors.initials: LA
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007223:Infant; D008297:Male; D009919:Orchiectomy / Q000706:statistics & numerical data*; D056126:Orchiopexy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000601:surgery*; D014481:United States