title: Trends in hospital admissions and surgical procedures for degenerative lumbar spine disease in England: a 15-year time-series study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Neurosurgery, St George's Hospital, London, UK.
authors.forename: Vinothan
authors.initials: V
authors.lastname: Sivasubramaniam
authors.affiliation: Department of Cardiology, The Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Hitesh C
authors.initials: HC
authors.lastname: Patel
authors.affiliation: Department of Vascular Surgery, St George's Hospital, London, UK London Deanery Surgical Rotation, UK.
authors.forename: Baris A
authors.initials: BA
authors.lastname: Ozdemir
authors.affiliation: Department of Neurosurgery, St George's Hospital, London, UK.
authors.forename: Marios C
authors.initials: MC
authors.lastname: Papadopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D017281:Cost of Illness; D004739:England; D005260:Female; D005544:Forecasting; D006760:Hospitalization / Q000639:trends*; D006761:Hospitals; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D017116:Low Back Pain / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000453:epidemiology* / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: NEUROSURGERY