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Methods use a retrospective Hospital Episode Statistics cohort of adults treated between April 2013 and March 2020, with 90-day mortality, length of stay, and 30-day emergency readmission as outcomes, analysed using multivariable logistic and quantile regression models. Results include 10,239 patients.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/patterns-of-care-and-outcomes-following-external-ventricular-drain-placement-insights-from-the-england-hes-administrative-data-set/443948/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/patterns-of-care-and-outcomes-following-external-ventricular-drain-placement-insights-from-the-england-hes-administrative-data-set/443948.png","ImageObject",300,407,{"name":92,"@type":93},"Quinn Holloway","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-04","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What study period and population were included for EVD insertion in England?","Question",{"text":112,"@type":113},"The retrospective cohort used Hospital Episode Statistics and included adult patients (≥16 years) who underwent EVD insertion between April 2013 and March 2020.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which outcomes were assessed after external ventricular drain placement?",{"text":117,"@type":113},"Outcomes included 90-day mortality, length of stay, and emergency readmission within 30 days.",{"name":119,"@type":110,"acceptedAnswer":120},"How did the timing of EVD relative to the index neurosurgical procedure affect mortality?",{"text":121,"@type":113},"Crude 90-day mortality varied by timing, with the highest mortality in the EVD-only group and the lowest when EVD was performed together with the index procedure.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},443948,1790952652,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},2336474466712,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Brain and Spine 6 (2026) 105906  \nContents lists available at ScienceDirect  \nBrain and Spine  \njournal [homepage:](homepage: www.journals.elsevier.com/brain-and-spine)[ www.journals.elsevier.com/brain-and-spine](homepage: www.journals.elsevier.com/brain-and-spine)  \n| Patterns of care and outcomes following external ventricular drain placement: Insights from the England HES administrative data set\u003Cbr>Daniel Thompson a,b,*, Adam Wahbac , Adam Williams b, Peter Hutchinson a, Adel Helmya, David Cromwell d\u003Cbr>a Department of Clinical Neurosciences, University of Cambridge, UK b Department of Neurosurgery, North Bristol NHS Trust, UK\u003Cbr>c Leeds Institute of Medical Research, School of Medicine, Worsley Building, University of Leeds, Leeds, LS2 9JT, UK d Department of Health Services Research and Policy, London School of Tropical Medicine, UK |  |  |\n| --- | --- | --- |\n| A R T I C L E I N F O |  | A B S T R A C T |\n| Keywords:\u003Cbr>External ventricular drain Performance monitoring Quality indicators\u003Cbr>Risk-adjustment |  | Objectives: To evaluate the outcomes of patients undergoing external ventricular drain (EVD) insertion in England, focusing on the timing of EVD relative to index neurosurgical procedures, and to assess the implications for benchmarking and performance monitoring between neurosurgical centres.\u003Cbr>Methods: We conducted a retrospective cohort study using Hospital Episode Statistics. Adult patients (≥16 years) undergoing EVD insertion between April 2013 and March 2020. Outcomes included 90-day mortality, length of stay (LOS), and emergency readmission within 30 days. Multivariable logistic regression was used for mortality and readmission, with adjustment for age, admission method, comorbidity (RCS Charlson index), and neurosurgical clinical category. A quantile regression model was performed with LOS as the outcome.\u003Cbr>Results: The cohort comprised 10,239 patients. Crude 90-day mortality was 26.7 % overall, highest in the EVDonly group (43.2 %) and lowest when EVD was performed with an index procedure (19.7 %). Mortality rose with age, comorbidity, emergency admission, and was highest in Oncology, Vascular, and General & Trauma categories. The final risk-adjustment model showed good discrimination (AUC 0.71) and reduced apparent inter-unit variation in mortality.\u003Cbr>Conclusions: Our findings demonstrate that treating all EVD insertions as a single cohort obscures clinically meaningful differences in patient trajectories and leads to misleading comparisons of outcomes. Although the absence of detailed severity markers in administrative data means that conclusions about quality of care must be interpreted cautiously, this study illustrates how carefully constructed, clinically meaningful cohorts can transform the interpretation of common neurosurgical procedures. |\n\n1. Introduction  \nThe insertion of external ventricular drains (EVDs) is a commonly performed neurosurgical procedure, often used in the management of raised intracranial pressure and the treatment of cerebrospinal fluid (CSF) infection (Muralidharan, 2015). The outcomes of patients managed using EVD are of interest to the Neurosurgical community given the volume of procedures and the potential for complications (Muralidharan, 2015; Mahto et al., 2023). This also makes the procedure a candidate for monitoring the quality of care received at different Neurosurgical centres since it is easier to reach a statistical significance when evaluating outcomes (Bottle et al., 2017; Kiernan et al., 2022).  \nEVDs are inserted in the management of a variety of pathologies but there has been a tendency in the literature to treat them as an homogenous group of patients, especially when assessing outcomes. The British Neurosurgical Trainee Research Collaborative (BNTRC) led audit looked into all EVD-related infections and demonstrated an in-hospital infection rate of 9.3 % as well as a 30-day mortality rate of 25.2 %(Jamjoom et al., 2018). Wahba et al. subsequently invest","cbCaikgxrTN0Vgrf","https://ap.wps.com/l/cbCaikgxrTN0Vgrf","pdf",1575140,"English","# Introduction\n# Methods\n## Study design and population\n# Outcomes\n## Mortality and length of stay\n## Readmission\n# Results\n# Conclusions","[{\"question\":\"What study period and population were included for EVD insertion in England?\",\"answer\":\"The retrospective cohort used Hospital Episode Statistics and included adult patients (≥16 years) who underwent EVD insertion between April 2013 and March 2020.\"},{\"question\":\"Which outcomes were assessed after external ventricular drain placement?\",\"answer\":\"Outcomes included 90-day mortality, length of stay, and emergency readmission within 30 days.\"},{\"question\":\"How did the timing of EVD relative to the index neurosurgical procedure affect mortality?\",\"answer\":\"Crude 90-day mortality varied by timing, with the highest mortality in the EVD-only group and the lowest when EVD was performed together with the index procedure.\"}]","Patterns of care and outcomes following external ventricular drain placement - Insights from the England HES administrative data set | PDF",1790706180,18]