Longitudinal neurosurgical activity in the NHS: a retrospective study

Objective: Neurosurgical care within the NHS has experienced significant shifts since 2000. Although consultant and national training numbers have risen, waiting lists have remained substantially high. This study aims to examine trends in neurosurgical activity at an NHS institution.

Methods: This is a retrospective study of neurosurgical activity between January 2000 to December 2023 at a single institution. Outcomes included annual inpatient and outpatient caseload, frequencies of cranial/spinal and elective/emergency procedures, staffing and productivity, neurosurgical infrastructure, and effects of the COVID-19 pandemic. The Shapiro-Wilk Test, Mann-Whitney U Test and repeated-measures ANOVA were used for statistical significance. Microsoft Excel and GraphPad Prism were used for data processing.

Results: 23,141 inpatient and 64885 outpatient cases were included. No significant difference was observed in the cumulative annual inpatient procedures over the study period. A significant increase was observed in the cumulative annual outpatient cases (r = 0.584, p < 0.01) and the proportion of elective surgeries performed over the study period (r = 0.6070, p < 0.01), along with a significant increase in the proportion of cranial surgeries performed during 2019 to 2021 (45.0% vs. 36.3%, p < 0.05). A significant surge was observed in the number of consultants employed over time (r = 0.9884, p < 0.0001), coinciding with significant decreases in annual levels of inpatient (r = -0.891, p < 0.0001) and outpatient (r = -0.933, p < 0.0001) activity per-consultant. No significant change was observed in the number of beds/theatres over time. A significant decrease in annual inpatient activity was observed during the COVID-19 pandemic compared to 2018 (592 vs. 787, p < 0.05). Following the pandemic, there was a significant rebound observed in both inpatient (1342 vs. 787, p < 0.01) and outpatient cases (3712 vs. 2355, p < 0.01), exceeding pre-pandemic levels.

Conclusion: Neurosurgical inpatient activity has remained largely stagnant despite an increase in outpatient caseloads, waitlists, and consultant staffing numbers, suggesting the role of other factors including the lack of infrastructural expansion within the NHS.