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

Study Overview
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Brief Summary
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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.

Official Title
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Patterns and Outcomes of Neurosurgery in England Over a Five-year Period: a National Retrospective Cohort Study

Conditions
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Comorbidities and Coexisting Conditions, Surgery, Surgery--Complications, Neurological Morbidity, Neurological Diseases or Conditions, Neurological Disorder, Neurological Complication, Neurological Procedural Complication, Outcome, Fatal, Morality

Intervention / Treatment
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* Procedure: Neurosurgical procedure


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Elective neurosurgery<br>Any elective neurosurgical procedure. | Procedure: Neurosurgical procedure<br>* Any neurosurgical procedure in the National Neurosurgical Audit Programme (NNAP) Coding Framework of neurosurgical procedures.<br>|
| Non-elective neurosurgery<br>Any non-elective neurosurgical procedure. | Procedure: Neurosurgical procedure<br>* Any neurosurgical procedure in the National Neurosurgical Audit Programme (NNAP) Coding Framework of neurosurgical procedures.<br>|

What is the study measuring?
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Primary Outcome Measures

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