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

Abstract

ObjectivesLow 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.DesignRetrospective 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 measuresTrends in the number of admissions and procedures for LBP, mean patient age, gender and length of stay.ResultsHospital 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).ConclusionsLBP 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.

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“…As with the general unexplained increase in lumbar surgery rates internationally 19,25,26 , there are also no obvious explanations to the increase observed in Norway. To our best knowledge, there was no increase in the prevalence, severity or surgical efficacy in LSS prior to or during the study period.…”

The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method

“…In the UK, the frequency of this type of surgery increased from 25 to 49 per 100,000 in the population over the period 1999-2013 [1]. In the USA, the surgery rate is considerably higher (135 per 100,000 in 2013), but does not show a further increase [2].…”

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

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