Ahmed Souid , Maithili Gopalakrishnan , Michael Basin , Glenn Cannon , Anthony Tracey , Matthew Mason , Andrew Osten , Jeffrey Villanueva
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引用次数: 0
Abstract
Background and objectives
Pediatric testicular torsion is a surgical emergency with known health disparities. The US News and World Report is an American media company that ranks colleges and hospitals based on annually published criteria. Hospitals that complied with the US News and World Report’s (USNWR) Speed in Treating Testicular Torsion (SiTTT) metric saw improved surgical testicular salvage rates, but the metric’s impact in mitigating inequities in testicular torsion is unstudied.
Methods
A retrospective cohort study of patients 1–18 years of age presenting with testicular torsion was performed using the Pediatric Health Information System database. Hospitals were classified based on their SiTTT score at the metric’s onset in 2015: they were labeled complete-scoring if they achieved the maximum score and partial-scoring otherwise. Surgical testicular salvage was defined as orchiopexy without concomitant orchiectomy. Testicular salvage rates were compared based on various socioeconomic variables including race between the pre-metric (2010–2015) and post-metric (2015–2019) periods with both univariate and adjusted, multivariate analyses.
Results
We identified 3950 cases of testicular torsion: 2335 in complete-scoring hospitals and 1615 in partial-scoring hospitals. Only partial-scoring hospitals improved significantly in salvage rate (pre-metric 61.0 % vs post-metric 67.5 %, p < 0.01). Subgroup analysis revealed the largest benefit in patients with economic or communicative barriers such as those with complex chronic conditions (pre-metric 35.3 % vs post-metric 61.1 %, p < 0.05). No minority races had statistically significant improvement after the metric, and salvage rate gap between White and all other races increased (pre-metric 4.3 % vs post-metric 10.0 %, p < 0.05).
Conclusions
Patients with communicative or economic barriers showed improved equity after efforts to comply with a third-party metric, but disparities persisted for minority races. Future studies may better classify the mediators of this association.
Type of study
Retrospective Cohort Study.
Level of Evidence
Level IV: Evidence from well-designed case–control or cohort studies.
期刊介绍:
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.