The Impact of Service Centralisation on Time to Theatre and Testicular Salvage in Testicular Torsion: A Retrospective Cohort Study

Introduction

Testicular torsion (TT) is a time-dependent urological emergency. Surgical exploration within six hours of symptom onset is reported to have a testicular salvage rate exceeding 90% , but this rapidly declines to below 50% if the delay extends past 12 hours. In 2017, the merger between Hinchingbrooke Hospital (HH) and Peterborough City Hospital (PCH) centralised urological services. This study aimed to evaluate whether this service reorganisation impacted key outcomes, including time to theatre and testicular salvage rates.

Methods

We conducted a retrospective cohort study of 98 patients who underwent scrotal exploration for suspected torsion. Data were collected from electronic and hard copy notes for the periods 2014–2020 at HH and 2016–2018 at PCH. The data points collected included the time of pain onset, presentation, referral, operative findings, and outcomes. Patients from HH transferred to PCH after the merger were included in the PCH post-merger group for analysis.

Results

A total of 98 patients were included. Pre-merger, HH had a 25% salvage rate for its 4 confirmed torsion cases. Post-merger, all 5 torsion cases from HH were salvaged (100% salvage rate). In contrast, PCH had a 100% salvage rate for its 10 pre-merger torsion cases, which fell to 82.4% for 17 torsion cases after the merger. The six-hour benchmark for timely exploration was rarely achieved across all groups, with mean times to theatre far exceeding this critical window.

Conclusion

The centralisation of services significantly improved outcomes for HH patients, with a 100% salvage rate post-merger. However, the decline in PCH’s salvage rate suggests that the centralisation of services and increased workload may have negatively impacted the primary surgical site. The persistent failure to meet the six-hour benchmark highlights significant multifactorial delays. These are likely due to a combination of late patient presentation and systemic inefficiencies in the care pathway. Further work is needed to optimise referral protocols and improve public awareness to minimise time to surgery