Introduction: Testicular salvage after testicular torsion is largely dependent on time to definitive management. Therefore, delay in presentation, diagnosis, or management can increase the risk of testicular loss. While several studies have examined the time burden of multiple components of the management course for testicular torsion, our study aims to evaluate other factors, including management by the day or on-call team, management by a pediatric or adult attending, and impact of patient age. Methods: A retrospective case-controlled study of patients with a history of testicular torsion between 2012 and 2022 at a single institution was conducted. Variables impacting testicular torsion management time was assessed using univariate analyses. Results: 134 patients were included, of whom 49 underwent an orchiectomy and 84 underwent an orchiopexy. There was no significant difference between efficiency of the on-call team versus day team regarding time from registration to ultrasound (113 vs 97 min, p = 0.37), ultrasound to urology consult (66 vs 86 min, p = 0.46), ED registration to OR (219 vs 196 min, p = 0.39), ultrasound to OR (155 vs 126 min, p = 0.30), and testicular salvage rate (35.7% vs 38.8%, p = 0.80). A difference was seen, however, when patients were stratified by age (>18 vs =18 years old). Patients greater than 18 years of age had significantly longer symptom duration (91.9 vs 20.0 min, p = 0.005), longer time to receive an ultrasound from ER registration (152 vs 87 min, p < 0.001), longer time to OR from ER registration (268 vs 185 min, p < 0.001) and longer time to OR from ultrasound read (187 vs 123 min, p = 0.03). In comparing pediatric attendings to adult attendings, there was no difference in time to surgery, intraoperative length of surgery, or testicular salvage rates. Intra-operatively, adult attending urologists had shorter length of surgery approaching significance (58minutes vs 65 min, p=0.07) and older patients had lower rates of testicular salvage approaching significance (orchiectomy rate 48.8% vs 31.5%, p=0.057). Conclusions: While no significant delays in testicular torsion management was detected between management by on-call versus day team nor pediatric versus adult attending, age of patient was associated with greater delays in receiving definitive surgical management of testicular torsion. Greater suspicion for testicular torsion diagnosis in older patients with acute scrotum may improve the rate of testicular salvage. SOURCE OF Funding: None.
