Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic.

Background: Over the past decade, neurosurgical interventions have experienced changes in operative frequency and postoperative length of stay (LOS), with the recent COVID-19 pandemic significantly impacting these metrics. Evaluating these trends in a tertiary National Health Service center provides insights into the impact of surgical practices and health policy on LOS and is essential for optimizing healthcare management decisions.

Methods: This was a single tertiary center retrospective case series analysis of neurosurgical procedures from 2012 to 2022. Factors including procedure type, admission urgency, and LOS were extracted from a prospectively maintained database. Six subspecialties were analyzed: () (), and (). Mann-Kendall temporal trend test and exploratory data analysis were performed.

Results: 19,237 elective and day case operations were analyzed. Of the 6 sub-specialties, , and procedures all showed a significant trend toward decreasing frequency. A shift toward day case over elective procedures was evident, especially in ( < 0.001), (tau = 0.733, = 0.0042), (tau = 0.156, = 0.0016), and surgeries ( < 0.005). Over the last decade, decreasing LOS was observed for (tau = -0.648, = 0.0077), (tau = -0.382, = 0.012), and operations, a trend which remained consistent during the COVID-19 pandemic ( = 0.01). remained constant across the decade while demonstrated a trend toward increasing LOS.

Conclusion: Most subspecialties demonstrate a decreasing LOS coupled with a shift toward day case procedures, potentially attributable to improvements in surgical techniques, less invasive approaches, and increased pressure on beds. Setting up extra dedicated day case theaters could help deal with the backlog of procedures, particularly with regard to the impact of COVID-19.