A large-scale study published in an international spine journal provides evidence that discharging patients on the same day after some types of low-complexity spinal surgery is no less safe than keeping them in hospital overnight.
The data-driven study in the Global Spine Journal – Safety of Same-Day Discharge Posterior Lumbar Decompression and/or Discectomy: An Observational Study Using Administrative Data From England – was carried out by a team of Getting It Right First Time (GIRFT) clinicians and researchers to support the programme’s work to increase rates of day surgery as part of the wider NHS drive to reduce elective waiting lists.
The findings support anecdotal evidence that patient outcomes are not adversely affected by the same-day discharge of patients under the age of 55 who have undergone surgery for posterior lumbar decompression and/or discectomy (known as PLDD – operations to relieve pain and pressure on the spinal cord in the lower back or to remove abnormal disc material). The study concludes that there is the potential for many providers in England to now increase their day case rates for PLDD operations to help free up bed capacity.
GIRFT’s national report for spinal services (2019) – authored by Mike Hutton – highlighted wide variation between providers in the provision of PLDD surgery as day case. Mr Hutton was among the GIRFT team involved in the new study, looking at data for almost 46,000 PLDD operations in England between 2014 and 2019, of which around 8,000 were performed as same day discharge.
Rates of same day discharge varied from 0% to 87.7% among trusts carrying out more than 50 procedures per year. Data analysis showed there were no more post-surgical emergency admissions among patients at trusts with higher same-day discharge rates than there were where more patients stayed overnight in hospital.
GIRFT is working to promote and share best practice to trusts to increase rates of PLDD being carried out as day case. Through its national review of spinal services, the programme identified the spinal surgery team at Northern Care Alliance NHS Foundation Trust (NCA) as an exemplar and has worked with the trust to detail its good practice and learning, to share with other spinal units working to improve their day surgery rates. Guidance on the Day Surgery Discectomy Pathway: Northern Care Alliance approach is now available to read and download on FutureNHS.
Members of the NCA team presented their approach at a webinar on 27th October 2022, where attendees had the opportunity to learn more and ask questions. Watch the recording of the session by clicking below.