Patterns and Outcomes of Neurosurgery in England Over a Five-year Period

Completed

• Conditions: Surgery--Complications; Neurological Complication; Neurological Diseases or Conditions; Morality; Surgery; Neurological Morbidity; Outcome, Fatal; Comorbidities and Coexisting Conditions; Neurological Disorder; Neurological Procedural Complication
• Interventions: Procedure: Neurosurgical procedure

• Registration Number: NCT05097066
• Lead Sponsor: University of Leeds

Brief Summary

Neurosurgical practice has seen many important changes over several decades with advances in treatments and the types of patients treated. Neurosurgical procedures have evolved, and as outcomes have improved the number of patients being treated has increased.

There are no recent evaluations of national neurosurgical practice in the United Kingdom (UK), with the last prospective cohort studies being Safe Neurosurgery 1993 and Safe Neurosurgery 2000. More recent studies of neurosurgical services have been based on data from single institutions or surgeons and these may not give a representative picture of practice nationally.

Recent national quality improvement programmes for neurosurgery in England (such as the National Neurosurgical Audit Programme (NNAP) and Cranial Neurosurgery and Spinal Surgery Getting It Right First Time (GIRFT) Programmes) have focused on using national hospital administrative datasets. To be effective, quality improvement initiatives require robust outcome measures and quality (process) indicators. Currently, there is a lack of validated quality indicators for neurosurgery, with practice often being described using generic measures such as readmission and reoperation rates and length of stay. Many studies have been able to derive these common outcome measures, but it may also be possible to produce indicators specific to neurosurgery.

The aim of this observational study was firstly to describe the current pattern of neurosurgical admissions and procedures in England, and thereby given an overview of the epidemiology of neurosurgical patients. Secondly, it aims to investigate the range of outcome measures that might be produced from hospital administrative data and use these to assess the quality of care in neurosurgery.

Detailed Description

Not available

Study Timeline

• Study Start: 2013-04-01
• Primary Completion: 2018-03-31
• Study Completion: 2018-03-31
• Study First Submitted: 2021-09-14
• Status Verified: 2021-10
• Study First Submitted QC: 2021-10-14
• Last Update Submitted: 2021-10-14
• Study First Posted: 2021-10-27
• Last Update Posted: 2021-10-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 371418

Inclusion Criteria

• All admissions to neurosurgical units in the National Health Service (NHS) in England.

Exclusion Criteria

• Records with poor quality data (e.g. no data for clinical diagnoses).
• Patients under 18 years that were admitted to an adult neurosurgical unit.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Non-elective neurosurgery	Neurosurgical procedure	Any non-elective neurosurgical procedure.
Elective neurosurgery	Neurosurgical procedure	Any elective neurosurgical procedure.

Primary Outcome Measures

Name	Time	Method
Length of stay	From date of admission to date of discharge from hospital; assessed up to 60 months.	Length of the hospital admission to neurosurgery
Proportion of patients discharged home	Determined on date of discharge from hospital; assessed up to 60 months.	Proportion of patients discharged to their normal address.
In-patient mortality rate	From date of the neurosurgical procedure through date of death from any cause (in-patient deaths only); assessed up to 60 months.	In-patient mortality after a neurosurgical procedure.
Additional inpatient neurosurgical procedure rate	From date of admission to date of discharge from hospital; assessed up to 60 months.	A further neurosurgical procedure in admissions where patients have had a primary (main) neurosurgical procedure.