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Factors associated with poorer outcomes for posterior lumbar decompression and or/or discectomy: an exploratory analysis of administrative data

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to identify factors associated with poorer patient outcomes for lumbar decompression and/or discectomy (PLDD).

Methods

We extracted data from the Hospital Episodes Statistics database for the 5 years from 1st April 2014 to 31st March 2019. Patients undergoing an elective one- or two-level PLDD aged ≥ 17 years and without evidence of revision surgery during the index stay were included. The primary patient outcome measure was readmission within 90 days post-discharge.

Results

Data for 93,813 PLDDs across 111 hospital trusts were analysed. For the primary outcome, greater age [< 40 years vs 70–79 years odds ratio (OR) 1.28 (95% confidence interval (CI) 1.14 to 1.42), < 40 years vs ≥ 80 years OR 2.01 (95% CI 1.76–2.30)], female sex [OR 1.09 (95% CI 1.02–1.16)], surgery over two spinal levels [OR 1.16 (95% CI 1.06–1.26)] and the comorbidities chronic pulmonary disease, connective tissue disease, liver disease, diabetes, hemi/paraplegia, renal disease and cancer were all associated with emergency readmission within 90 days. Other outcomes studied had a similar pattern of associations.

Conclusions

A high-throughput PLDD pathway will not be suitable for all patients. Extra care should be taken for patients aged ≥ 70 years, females, patients undergoing surgery over two spinal levels and those with specific comorbidities or generalised frailty.

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Availability of data and materials

This report does not contain patient identifiable data. The data in this report are anonymised. Request for any underlying data cannot be granted as the data are calculated from data under licence/data sharing agreement from NHS Digital and/or other data provider where conditions of use (and further use) apply. The data can be obtained from NHS Digital upon request.

Availability of code

Data were analysed using the Stata software. The code used in the analysis was relatively trivial, but can be made available by the authors upon request.

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Acknowledgements

The authors acknowledge The UK ONS and NHS Digital for permission to use their data in this report. They also thank all staff within individual NHS trusts who collected and entered the data used in this study.

Funding

Johannes Heyl and Flavien Hardy conducted this work as part of a fellowship from Distributed Research utilising Advanced Computing (DiRAC), which is funded by the Science and Technology Facilities Council (grant numbers ST/S003916/1 and ST/W002760/1).

Author information

Authors and Affiliations

  1. Department of Physics and Astronomy, University College London, London, UK

    Johannes Heyl

  2. Getting It Right First Time Programme, NHS England, London, UK

    Johannes Heyl, Flavien Hardy, William K. Gray, Tim W. R. Briggs & Mike Hutton

  3. Innovation and Intelligent Automation Unit, Royal Free London NHS Foundation Trust, London, UK

    Katie Tucker

  4. Science and Technology Facilities Council Distributed Research Utilising Advanced Computing (DiRAC) High Performance Computing Facility, London, UK

    Maria J. M. Marchã & Jeremy Yates

  5. Department of Computer Science, University College London, London, UK

    Jeremy Yates

  6. Royal National Orthopaedic Hospital, Stanmore, London, UK

    Tim W. R. Briggs

  7. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

    Mike Hutton

Authors
  1. Johannes Heyl
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  2. Flavien Hardy
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  3. William K. Gray
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  4. Katie Tucker
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  5. Maria J. M. Marchã
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  6. Jeremy Yates
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  7. Tim W. R. Briggs
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  8. Mike Hutton
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Contributions

This study was designed and organised by JH, FH, MH, MM, KT, JM, TWRB and WKG. Data cleaning, analysis and writing of the first draft was by JH supported by FH and WKG. All authors critically reviewed the manuscript and agreed to submission of the final draft.

Corresponding author

Correspondence to William K. Gray.

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Conflict of interest

The authors declare that there is no conflict of interest.

Consent to participate

Informed consent was not sought for the present study because it was an analysis of routine clinical data.

Ethical approval

Ethical approval was not sought for the present study because it did not directly involve human participants. This study was completed in accordance with the Helsinki Declaration as revised in 2013.

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Not applicable.

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Heyl, J., Hardy, F., Gray, W.K. et al. Factors associated with poorer outcomes for posterior lumbar decompression and or/or discectomy: an exploratory analysis of administrative data. Arch Orthop Trauma Surg 144, 1129–1137 (2024). https://doi.org/10.1007/s00402-023-05182-5

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  • DOI: https://doi.org/10.1007/s00402-023-05182-5

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