Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic

Ella Snowdon; Sayan Biswas; Zahra R Almansoor; Luqman Naim Bin Aizan; Xin Tian Chai; Sharan Manikanda Reghunathan; Joshua MacArthur; Callum James Tetlow; Ved Sarkar; K Joshi George

doi:10.25259/SNI_787_2023

Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic

Surg Neurol Int. 2023 Nov 24:14:407. doi: 10.25259/SNI_787_2023. eCollection 2023.

Affiliations

¹ Department of Neurosurgery, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
² Department of Colorectal Surgery, Warrington and Halton Foundation Trust, Warrington, United Kingdom.
³ Department of Data Science, National Health Service (NHS) Northern Care Alliance, Manchester, United Kingdom.
⁴ Department of Data Science, College of Letters and Sciences, University of California, Berkeley, United Kingdom.
⁵ Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Salford, United Kingdom.

Abstract

Background: Over the past decade, neurosurgical interventions have experienced changes in operative frequency and postoperative length of stay (LOS), with the recent COVID-19 pandemic significantly impacting these metrics. Evaluating these trends in a tertiary National Health Service center provides insights into the impact of surgical practices and health policy on LOS and is essential for optimizing healthcare management decisions.

Methods: This was a single tertiary center retrospective case series analysis of neurosurgical procedures from 2012 to 2022. Factors including procedure type, admission urgency, and LOS were extracted from a prospectively maintained database. Six subspecialties were analyzed: Spine, Neuro-oncology, Skull base (SB), Functional, Cerebrospinal fluid (CSF), and Peripheral nerve (PN). Mann-Kendall temporal trend test and exploratory data analysis were performed.

Results: 19,237 elective and day case operations were analyzed. Of the 6 sub-specialties, spine, neuro-oncology, SB, and CSF procedures all showed a significant trend toward decreasing frequency. A shift toward day case over elective procedures was evident, especially in spine (P < 0.001), SB (tau = 0.733, P = 0.0042), functional (tau = 0.156, P = 0.0016), and PN surgeries (P < 0.005). Over the last decade, decreasing LOS was observed for neuro-oncology (tau = -0.648, P = 0.0077), SB (tau = -0.382, P = 0.012), and functional operations, a trend which remained consistent during the COVID-19 pandemic (P = 0.01). Spine remained constant across the decade while PN demonstrated a trend toward increasing LOS.

Conclusion: Most subspecialties demonstrate a decreasing LOS coupled with a shift toward day case procedures, potentially attributable to improvements in surgical techniques, less invasive approaches, and increased pressure on beds. Setting up extra dedicated day case theaters could help deal with the backlog of procedures, particularly with regard to the impact of COVID-19.

Keywords: COVID-19; Length of stay; National Health Service; Neurosurgical operations; Temporal trend analysis.