Sex-based Disparities in the Management of Pediatric Gonadal Torsion

In 2015, the U.S. News and World Report (USNWR) implemented a quality metric to expedite surgery for testicular torsion (TT), but not ovarian torsion (OT). This study examined OR timing among children with suspected TT and OT before and after this metric. A single-center retrospective cohort study of children (1–18yr) who underwent surgery for suspected gonadal torsion was performed. Time to OR (TTOR) from hospital presentation to surgery start was calculated. An interrupted time series analysis identified changes in TTOR for suspected TT versus OT after the 2015 USNWR quality metric. Overall, 216 patients presented with TT and 120 with OT. Median TTOR for TT was 147 min (IQR:99–198) versus 462 min (IQR:308–606) for OT. Post-quality metric, children with TT experienced a 27.8 min decrease (95% CI:-51.7,-3.9, p = 0.05) in annual median TTOR. No significant decrease was observed for children with OT (p = 0.22). Children with history of a known ovarian mass (N = 62) experienced a shorter TTOR compared to those without (422 vs 499min; p = 0.04). Implementation of a national quality metric for TT expedited surgical care for children with TT, but not children with OT. These findings highlight the need for equitable quality metrics for children presenting with suspected gonadal torsion. III. Retrospective Comparative Study, Observational Cohort Study. •Since 2015, national quality metrics have encouraged the expedited surgical care of children with suspected testicular torsion in order to improve gonadal salvage. However, similar metrics for ovarian torsion are lacking.•Following implementation of the U.S. News and World Report quality metric for expedited care of testicular torsion, time to surgery decreased significantly.•However, children with suspected ovarian torsion did not experience a significant change in time to surgery.•This highlights the need for equitable quality metrics in pediatric gonadal torsion.