Disparities in Time to Operation in Adults Presenting to the Emergency Department with Gonadal Torsion

Abstract

Background: Ovarian and testicular torsion are fertility threatening surgical emergencies and represent relatively frequent emergency department (ED) presentations.

Objectives: The current study aimed to evaluate for association between demographics and time-related endpoints related to evaluation and management of gonadal torsion in adults presenting to the ED. The primary endpoint was time from ED presentation to arrival in the operating room (tOR). Secondary endpoints included times from ED presentation to radiology-performed ultrasound (tUS) and to specialist consultation.

Methods: We assessed four years (2020-23) of adult (age > 18) gonadal torsion patients diagnosed in an urban academic center. Eligible cases were those with a primary diagnosis of gonadal torsion.

Results: Of 57 patients, 45 were female sex (79.0%). Race was most commonly White (35, 61.4%), with 9 patients (15.8%) each in categories of Hispanic or Black/African-American and remaining 4 patients (7.0%) were Asian. 48 (84.2%) of 57 torsion patients went directly from the ED to OR. Univariate analysis found that compared to males, tOR for females was prolonged by 156 min (95% CI: 79-239), and tUS was prolonged by 32 min (95% CI: 7-66). Multivariable QR confirmed longer tOR for females (128 min, 95% CI: 5-251, p = 0.042) and found prolonged tOR for Asians as compared to Whites (229 min, 95% CI: 49-409, p = 0.014) although with small subgroup numbers.

Conclusions: Despite constituting a substantial majority of adult ED patients with gonadal torsion, time from presentation to ultrasound was prolonged by more than 30 min and operative intervention was prolonged by over 2 h for females as compared to males.

Keywords: disparities; gender; gonadal torsion; ovarian torsion; testicular torsion.