BASS Audit 2010

Martyn Newey

Clinical Audit

..about measuring the quality of care and services against agreed standards and making improvements where necessary

Contributing Hospitals & Surgeons

• • • • • • • • • Gloucester Royal Hospital University Hospitals of Leicester Royal Derby Hospital Northern General Hospital, Sheffield Spire Fylde Coast Hospital The Countess of Chester Queen Elizabeth Queen Mother, Margate The Royal Berkshire Hospital Woodland Hospital J Craig P Sell Z Klezl A Cole R Smith I Braithwaite J Casha R Marshall N Birch

Auditors

• Gloucester Royal Hospital • • • • • University Hospitals of Leicester Royal Derby Hospital Northern General Hospital, Sheffield Spire Fylde Coast Hospital The Countess of Chester • • • Queen Elizabeth Queen Mother, Margate Woodland Hospital The Royal Berkshire K Teoh V Budnar B Williams P Sell M Jones JD Bowe C Gardner I McLaughlin-Symon J Malal S Elnikety C Heywood TS Rajagopal D Williams

Audit topics

• Single-level, unilateral primary lumbar discectomies in patients ≤ 50 years • L4-5 degenerative spondylolisthesis • Multi-level decompressive surgery • Audit period 1st January 2009 to 31st December 2009

Single level, unilateral, primary lumbar discectomies aged <=50 • • • 327 patients in 8 centres Mean age 38 yrs (range 13-50) Left 165, Right 148

197 200 180 160 140 120 100 80 60 40 20 0 1 1 5 122 L1/2 L2/3 L3/4 L4/5 L5/S1

Outcome measures

• • Pre-op VAS Post-op VAS • • Pre-op ODI Post-op ODI 6.7 – 8 0.5 – 2.4

24 – 60 5 – 26 (68%) (56%) (57%) (53%)

Complications

• • • • Recurrence Dural tear Infection Nerve injury 4 11 2 1 (1.2%) (3.4%) (0.6%) (0.3%)

L4-5 degenerative spondylolisthesis • • 74 patients in 4 centres Average age 67 yrs (range 51 - 83)  ISPD  Decompression, no fusion  Decompression, uninstrumented fusion  Decompression, instrumented fusion 2 15 6 49

Outcome measures

• • Pre-op VAS Post-op VAS • • Pre-op ODI Post-op ODI 5.6 – 9 1 – 1.5

44 - 49 17 - 32 (74%) (57%) (69%) (55%)

Complications

• Dural Tear • Infection 4 (5.4%) 2 (2.7%) • Screw breakage 1 (1.4%) • Removal of metalwork 1

3-Level or more decompressions

• • 33 patients in 5 centres Average age 69 yrs (range 53 – 82)  3-level  4-level 25 8

Length of Stay

9 8 7 3 2 1 6 5 4 0 1- 2 days 3-4 days 5-6 days 7-8 days 9-10 days >10 days LOS

Outcome measures

• • Pre-op VAS Post-op VAS • • Pre-op ODI Post-op ODI 5 – 9 2 – 5 37 - 62 0 - 50 (79%) (76%) (30%) (27%)

Complications

• • Dural tear Infection 4 1 (12%) (3%) • 1 patient required HDU post-op

HQIP

• • • • Commit to clinical audit, intellectually and by conviction Endeavour to improve our own clinical audit skills Instigate and participate in audit Strive to improve clinical audit through ..time ….and leadership • • Act on the results to improve practice, including our own Lead on CA where empowered to do so

BASS Audit 2010

…is based on 434 patients from 20 surgeons working in 9 centres with data that was only complete in 27 to 79% of cases.