Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study

Abstract

Objectives: Low back pain (LBP), from degenerative lumbar spine disease, represents a significant burden on healthcare resources. Studies worldwide report trends attributable to their country's specific demographics and healthcare system. Considering England's specific medico-socioeconomic conditions, we investigate recent trends in hospital admissions and procedures for LBP, and discuss the implications for the allocation of healthcare resources.

Design: Retrospective cohort study using Hospital Episode Statistics data relating to degenerative lumbar spine disease in England, between 1999 and 2013. Regression models were used to analyse trends.

Outcome measures: Trends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay.

Results: Hospital admissions and procedures have increased significantly over the study period, from 127.09 to 216.16 and from 24.5 to 48.83 per 100,000, respectively, (p<0.001). The increase was most marked in the oldest age groups with a 1.9 and 2.33-fold increase in admissions for patients aged 60-74 and ≥ 75 years, respectively, and a 2.8-fold increase in procedures for those aged ≥ 60 years. Trends in hospital admissions were characterised by a widening gender gap, increasing mean patient age, and decreasing mean hospital stay (p<0.001). Trends in procedures were characterised by a narrowing gender gap, increasing mean patient age (p=0.014) and decreasing mean hospital stay (p<0.001). Linear regression models estimate that each hospital admission translates to 0.27 procedures, per 100,000 (95% CI 0.25 to 0.30, r 0.99, p<0.001; r, Pearson's correlation coefficient). Hospital admissions are increasing at 3.5 times the rate of surgical procedures (regression gradient 7.63 vs 2.18 per 100,000/year).

Conclusions: LBP represents a significant and increasing workload for hospitals in England. These trends demonstrate an increasing demand for specialists involved in the surgical and non-surgical management of this disease, and highlight the need for services capable of dealing with the increased comorbidity burden associated with an ageing patient group.

Keywords: NEUROSURGERY.

Figure 1

Hospital admissions for low back pain in England, 1999–2013. Solid line—admissions per 100 000 population, dashed line—linear regression model.

Figure 2

Male and female hospital admissions for low back pain, 1999–2013. Solid lines—admissions per 100 000 population, dashed lines—linear regression model.

Figure 3

Hospital admissions for low back pain in England by age groups, 1999–2013.

Figure 4

Age specific annual rate of increase in hospital admissions and procedures, 1999–2013. Values correspond to each age group’s β coefficient with their respective 95% CIs represented as error bars.

Figure 5

The number of surgical procedures performed for degenerative lumbar spine disease, 2000–2013. Solid line—number of procedures per 100 000 population. Dashed line—linear regression model.

Figure 6

Number of surgical procedures for degenerative lumbar spine disease by age groups, 2000–2013.