Timing and outcomes of testicular torsion during the COVID-19 crisis

Summary Background During the COVID-19 crisis, there has been widespread reporting that non-COVID-19-related medical care has been delayed, even for emergent conditions. Testicular torsion is an emergent condition with higher risk of testicular loss with longer ischemic times. We sought to investigate whether patients with testicular torsion had longer time from symptom onset to initial presentation, longer total ischemic time, and higher rate of orchiectomy during the pandemic. Materials and methods Using billing data, we identified all patients age >1yo seen in our hospital from 1/1/2018 through 5/31/2020 who underwent emergent scrotal exploration for confirmed testicular torsion, comparing the COVID-19 crisis (3/1/2020–5/31/20) to the pre-COVID-19 period (1/1/2018–2/29/20). The primary outcome was time from symptom onset to initial presentation and secondary outcomes were ischemic time (time from symptom onset to entry of the OR) and orchiectomy rate. Parameters were compared with Mann–Whitney U and Fisher's exact tests; Poisson regression compared rates of torsion. Results Of 94 total cases, 77 occurred during the pre-COVID-19 period and 17 during the COVID-19 crisis. Median time from symptom onset to initial presentation was not significantly different (2.4 h [IQR 1.1 h–38.9] during COVID-19 vs. 5.6 h [IQR 1.6–16.9] during pre-COVID-19 period, p = 0.476). Time to presentation was >12 h in 5/17 patients (29%) during COVID-19 and 24/77 patients (31%) during pre-COVID-19 period (p = 1.00). Median ischemic time during COVID-19 was 7.5 h (IQR 4.7 h–45.5 h) compared to 9.4 h (IQR 5.4 h–22.5 h) during pre-COVID-19 period (p = 0.694). Incidence of orchiectomy in our center was 29% (5/17) during COVID-19 and 17% (13/77) during pre-COVID-19 period (p = 0.397). About half of patients were seen initially at outside facilities prior to arrival (47% [8/17] during COVID-19 vs. 49% [38/77] during pre-COVID-19 period, p = 1.00). The number of torsion case presentations per week to our facility increased from 0.7 cases/week in the pre-COVID-19 period to 1.3 cases/week during COVID-19 (p = 0.015); when comparing only the March 1 to May 31 calendar period, there were 0.6 cases/week during the pre-COVID-19 period and 1.3 cases/week during COVID-19 (p = 0.021). Conclusion Time to presentation, ischemic times, and orchiectomy rates for testicular torsion at our center were not significantly different during the COVID-19 period compared to the preceding 2 year period. The number of torsion case per week presenting to our facility increased significantly. Summary Table 1 . Comparison of patients, timing, and testicular outcomes among patients with testicular torsion before and during COVID-19 crisis. Overall Pre-COVID COVID p-value n 94 77 17 Age, years (median [IQR]{range}) 14.38 [12.70, 15.87] {1.3–19.7} 14.22 [12.64, 15.83]{1.3–19.7} 15.24 [14.21, 16.01]{4.2–17.4} 0.2950 Time from symptom onset to presentation, hours (median [IQR]{range}) 5.38 [1.49, 18.38]{0.7, 148.0} 5.58 [1.60, 16.85]{0.7, 81.3} 2.40 [1.12, 38.92]{0.9, 148.0} 0.4760 Time from symptom onset to presentation > 6 h, n (%) 43 (45.7) 35 (45.5) 8 (47.1) 1.0000 Time from symptom onset to presentation > 12 h, n (%) 29 (30.9) 24 (31.2) 5 (29.4) 1.0000 Ischemic time, hours (Time from symptom onset to OR) (median [IQR]{range}) 9.19 [5.32, 26.02]{2.7, 152.2} 9.40 [5.42, 22.52]{2.7, 86.3} 7.52 [4.67, 45.45]{2.7, 152.2} 0.6940 Orchiectomy, n (%) 18 (19.1) 13 (16.9) 5 (29.4) 0.3970 Presentation at OSH, n (%) 46 (48.9) 38 (49.4) 8 (47.1) 1.0000