Urology Department, Hadassah Medical Center and Hebrew University, Jerusalem, Israel.
Braun School of Public Health and Community Medicine, Hadassah Medical Center and Hebrew University, Jerusalem, Israel.
Urology. 2019 Nov;133:211-215. doi: 10.1016/j.urology.2019.08.003. Epub 2019 Aug 10.
To determine the importance of the duration of in-hospital management of patients with testicular torsion for testes survival. The time from onset of symptoms until surgery is a well-known factor determining testicular survival but there is no data regarding the contribution of in-hospital management duration to testicular survival. Unlike the time from onset of symptoms until seeking medical attention, the time from registration to the emergency department (ED) to the time of detorsion-"Door To Detorsion time" (DTD) is dependent on medical providers and should be minimized.
Data was retrieved on all patients who underwent surgery for testicular torsion in 1994-2014 (N = 219). We used multivariable logistic regression analysis to examine independent association between DTD time or duration of symptoms to testicular survival.
Median DTD time was 135 minutes (range 23-546). Among patients with a viable testis, median DTD time was 107 minutes (range 35-381) compared to 160 minutes (range 23-546) among patients with a nonviable testis (P <.001). Logistic regression models showed that both DTD time (P = .04) and duration of symptoms (P <.001) are independent factors associated with testicular survival. Adjusted odds ratio was 1.0048 for a nonviable testis for every minute of delayed management in the ED (P = .04). Results suggest that every 10 minutes of delay in the ED increases the chance of having a nonviable testis in exploration by 4.8%.
DTD is an independent factor predicting testicular survival. Institutional efforts should be made to decrease duration of DTD. DTD should be considered as a measure for quality of care.
确定患者睾丸扭转住院管理时间对睾丸存活的重要性。从症状发作到手术的时间是决定睾丸存活的一个众所周知的因素，但目前还没有关于住院管理时间对睾丸存活贡献的数据。与从症状发作到寻求医疗帮助的时间不同，从挂号到急诊科（ED）再到松解时间的时间——“从挂号到松解时间”（DTD）取决于医疗服务提供者，并且应该尽量缩短。
检索了 1994 年至 2014 年期间因睾丸扭转接受手术的所有患者的数据（n=219）。我们使用多变量逻辑回归分析来检查 DTD 时间或症状持续时间与睾丸存活之间的独立关联。
中位 DTD 时间为 135 分钟（范围 23-546）。在有存活睾丸的患者中，中位 DTD 时间为 107 分钟（范围 35-381），而在无存活睾丸的患者中为 160 分钟（范围 23-546）（P<0.001）。逻辑回归模型显示，DTD 时间（P=0.04）和症状持续时间（P<0.001）都是与睾丸存活相关的独立因素。ED 每延迟管理 1 分钟，非存活睾丸的调整后比值比为 1.0048（P=0.04）。结果表明，ED 每延迟 10 分钟，探查中出现非存活睾丸的几率增加 4.8%。
DTD 是预测睾丸存活的独立因素。应努力减少 DTD 的持续时间。DTD 应被视为衡量护理质量的一个指标。
