Higher rates of orchiectomy in testicular torsion are associated with substandard health literacy.

BACKGROUND

Testicular torsion is an emergency that may result in orchiectomy if not addressed promptly. Orchiectomy rates approach 40 % when presentation is delayed more than 12 h. Pediatric emergency department (ED) protocols to triage acute scrotal pain have mitigated system-based delays to treatment. Despite these initiatives, high rates of orchiectomy remain, likely due to delayed presentation to the ED. In the United States, 12 % of adults have proficient health literacy, defined as the ability to use information and services to inform health-related decisions. We hypothesize that patients from areas with low health literacy are associated with higher rates of orchiectomy.

METHODS

An administrative billing database was queried from October 2015 to March 2023 to identify patients with acute intravaginal testicular torsion that underwent orchiectomy and contralateral orchidopexy (OCO) or bilateral orchidopexy (BO). Patients under 8 years old were excluded. Demographic information and the distance from the patient's home to the hospital was collected. Health literacy estimates were obtained from University of North Carolina health literacy map. Average health literacy estimates were categorized into quartiles. 2019 Social deprivation index (SDI) information by zip code was assigned to each patient.

RESULTS

1044 patients underwent surgery for testicular torsion,942 patients met all clinical inclusion criteria, and of those 841 had available health literacy data. In this cohort, 275 patients (32.7 %) underwent OCO, and 566 (67.3 %) underwent BO. Median age at surgery was 14.2 ± 1.89 years for the OCO group and 13.8 ± 2.0 for the BO group (p = 0.012). Average health literacy per zip code for OCO group was 239.17 ± 11.25 and 241.6 ± 12.5 for the BO group (p < 0.05). Of the patients who underwent OCO, 74.1 % patients came from zip codes with the lowest 2 quartiles of health literacy compared to 64.9 % in the BO group (p < 0.001). Lower health literacy and >50 miles from the hospital were significantly associated with an increased risk of OCO. There was no significant difference between the OCO and BO groups regarding urban, suburban, rural zip codes, insurance status, or SDI quartile.

CONCLUSION

Quality improvement initiatives have been implemented to minimize time from ED presentation to surgery. However, patient-related factors significantly contribute to outcomes. Our study reveals a correlation between lower rates of health literacy and increased rates of orchiectomy. By analyzing data on specific zip codes, targeted education plans can help to improve health literacy and knowledge of testicular torsion to continuously decrease orchiectomy rates in cases of testicular torsion.