Longitudinal Trends and Socioeconomic Disparities in Testicular Torsion and Orchiectomy Spanning the COVID-19 Era: A Pediatric Health Information System Database Study

INTRODUCTION: The impact of COVID-19 on testicular torsion frequency, management, and outcomes remains underexplored, with existing studies showing inconsistent results. This study aims to assess the frequency of testicular torsion, orchiectomy rates, and associated demographic and socioeconomic risk factors before, during, and after the pandemic. METHODS: The U.S.-based Pediatric Health Information System (PHIS) database was queried to identify patients (1-18 years) diagnosed with testicular torsion (International Classification of Diseases, 10th Revision (ICD-10) codes N44.0 and N44.01) who underwent surgical treatment (Current Procedural Terminology (CPT) codes 54520, 54550, 54560, 54640, 54650, 54692, 54600, and 54620) between March 13, 2018, and June 30, 2024. We analyzed demographic data, calculated frequencies of torsion and rates of orchiectomy, and compared findings across three periods: pre-COVID-19 (March 13, 2018, to March 13, 2020), during COVID-19 (March 14, 2020, to March 13, 2021), and post-COVID-19 (March 14, 2021, to June 30, 2024). RESULTS: Of the 12,399 patients with testicular torsion, 2,792 (22.5%) underwent orchiectomy. The number of testicular torsion cases per month increased before and during the pandemic, then plateaued post-pandemic. The number of cases per month was highest in those aged 12-14 years, followed by ≤12 years, and was higher in non-Hispanic White individuals. Orchiectomy rates showed a slight downward trend over time. Rates were highest in younger patients (≤12 years), were consistently higher in non-White patients than in White patients, and were lower in patients with commercial insurance compared with other insurance types. Adjusted odds ratios for orchiectomy were higher in younger patients, non-White patients, and patients with Medicaid insurance across all time periods. DISCUSSION: The observed monthly frequency of testicular torsion trended upward before and during the COVID-19 pandemic and subsequently stabilized in the post-pandemic period, while orchiectomy rates declined slightly and were not affected by the pandemic. Younger and non-White patients had higher odds of orchiectomy, whereas patients with commercial insurance had lower odds. Limitations include those inherent to administrative databases, lack of true incidence data, and potential regional differences in healthcare access, which may affect generalizability. CONCLUSION: The monthly frequency of testicular torsion increased before and during the COVID-19 pandemic and subsequently plateaued in the post-pandemic period. The COVID-19 pandemic did not significantly alter orchiectomy rates. Younger age, non-White race, and non-commercial insurance were associated with increased odds of orchiectomy, and this effect was not altered by the pandemic.