title: Patterns of care in testicular torsion: influence of hospital transfer on testicular outcomes.
abstract: OBJECTIVE
  To investigate patterns of care for testicular torsion and influence of hospital transfers on testicular outcomes. Hospital transfer may be a source of treatment delay in a condition where delays increase likelihood of orchiectomy.
  
  
  METHODS
  We used a retrospective cohort of Californian males with ICD-9/CPT-defined torsion from inpatient, emergency department (ED), and ambulatory surgery center (ASC) data. Logistic regression assessed predictors of orchiectomy.
  
  
  RESULTS
  Predictors of orchiectomy were ages <1 year (OR 19.2, 95% CI 6.3-58.9), 1-9 years (OR 2.7, 95% CI 1.4-5.2), and ≥40 years (OR 6.6, 95% CI 3.1-13.9) (vs. masked age). Treatment at mid-volume (vs. high-volume) facilities was associated with lower odds of orchiectomy (OR 0.5, 95% CI 0.3-0.7). Rural location, non-private insurance, and hospital transfer were associated with orchiectomy on univariate but not multivariate analysis. During 2008-2010, 2794 subjects experienced torsion (average incidence 5.08 per 100,000 males yearly). Encounters occurred in ASCs (55%), inpatient facilities (36%), and EDs (9%). 60% of subjects were privately insured, 2% experienced hospital transfer, and 31% underwent orchiectomy.
  
  
  CONCLUSIONS
  Our census found that most cases of testicular torsion were treated in outpatient settings. Hospital transfer was not associated with orchiectomy.
authors.affiliation: University of California Los Angeles, Department of Urology, BOX 957383, 924 Westwood Blvd., Ste. 1000, Los Angeles, CA 90095-1738, United States. Electronic address: jennyyiee@yahoo.com.
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Yiee
authors.forename: Lynne
authors.initials: L
authors.lastname: Chang
authors.forename: Alan
authors.initials: A
authors.lastname: Kaplan
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009919:Orchiectomy / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011364:Professional Practice / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013086:Spermatic Cord Torsion / Q000453:epidemiology* / Q000601:surgery*; D055815:Young Adult
keywords: Clinical practice patterns; Epidemiology; Health services research; Orchiectomy; Outcome assessment; Testicular torsion
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