Journal of pediatric urology · 2026
Impact of nighttime centralization on timeliness of care for pediatric acute scrotum: A regional retrospective study in Yamanashi prefecture, Japan.
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Mochizuki Takanori, Sawada Norifumi, Abe Akira, Shimura Hiroshi, Kobayashi Anna, Goto Miwa, Kira Satoru, Mitsui Takahiko
Аннотация
OBJECTIVE: To evaluate whether nighttime centralization of pediatric acute scrotum management improves timeliness of care and surgical outcomes in a rural regional network.
METHODS: We conducted a retrospective cohort study of 215 pediatric acute scrotum cases managed between 2003 and 2024 in Yamanashi Prefecture, Japan. Nighttime centralization was implemented in October 2018, designating a single receiving institution during off-hours. Outcomes before (2003-2017) and after (2018-2024) centralization were compared. Time intervals were analyzed when complete timestamps were available and restricted to ≤1440 min. Continuous variables were compared using the Mann-Whitney U test.
RESULTS: A total of 215 cases were included (Before n = 103; After n = 112). Baseline characteristics, including age distribution and proportion of confirmed torsion among surgical cases, were comparable between periods. Following centralization, annual case volume increased, while surgical and salvage proportions remained stable. Of the total cohort, 195 cases were included in the onset-to-consultation analysis, and 68 cases were included in the consultation-to-surgery analysis after exclusion of intervals >24 h. Median onset-to-consultation time did not differ between eras (300 vs 296 min, p = 0.708). Among surgically treated cases, median consultation-to-surgery time showed no significant difference (133 vs 143 min, p = 0.107). Among cases with complete onset and surgery timestamps (n = 52), orchiectomy was associated with longer onset-to-surgery intervals compared with salvaged testes (630 vs 416 min, p = 0.068).
CONCLUSIONS: Nighttime centralization increased case capture without worsening in-hospital delay or compromising testicular salvage. Pre-hospital delay remained unchanged. These findings suggest that nighttime centralization functions as a capacity-preserving system reorganization, maintaining in-hospital timeliness despite increased case volume, rather than directly reducing pre-hospital delays.
METHODS: We conducted a retrospective cohort study of 215 pediatric acute scrotum cases managed between 2003 and 2024 in Yamanashi Prefecture, Japan. Nighttime centralization was implemented in October 2018, designating a single receiving institution during off-hours. Outcomes before (2003-2017) and after (2018-2024) centralization were compared. Time intervals were analyzed when complete timestamps were available and restricted to ≤1440 min. Continuous variables were compared using the Mann-Whitney U test.
RESULTS: A total of 215 cases were included (Before n = 103; After n = 112). Baseline characteristics, including age distribution and proportion of confirmed torsion among surgical cases, were comparable between periods. Following centralization, annual case volume increased, while surgical and salvage proportions remained stable. Of the total cohort, 195 cases were included in the onset-to-consultation analysis, and 68 cases were included in the consultation-to-surgery analysis after exclusion of intervals >24 h. Median onset-to-consultation time did not differ between eras (300 vs 296 min, p = 0.708). Among surgically treated cases, median consultation-to-surgery time showed no significant difference (133 vs 143 min, p = 0.107). Among cases with complete onset and surgery timestamps (n = 52), orchiectomy was associated with longer onset-to-surgery intervals compared with salvaged testes (630 vs 416 min, p = 0.068).
CONCLUSIONS: Nighttime centralization increased case capture without worsening in-hospital delay or compromising testicular salvage. Pre-hospital delay remained unchanged. These findings suggest that nighttime centralization functions as a capacity-preserving system reorganization, maintaining in-hospital timeliness despite increased case volume, rather than directly reducing pre-hospital delays.