LOW-BACK-PAIN HOSPITALIZATION IN WASHINGTON-STATE - RECENT TRENDS ANDGEOGRAPHIC VARIATIONS

For several years, interest in clinical practice patterns has increase d due to concerns about the costs and quality of health care. Our obje ctives were to examine recent trends and geographic variations in low back pain hospitalization. We analyzed data from a Washington State au tomated database for 1987-1992. Low back surgery rates in Washington c hanged little during the study years. In contrast, nonsurgical hospita lization rates fell from 15.5 to 5.1 per 10,000. The proportion of ope rations involving fusion decreased from 15.8% in 1987 to 11.7% in 1990 , and then remained stable. During 1990, important county-to-county va riations were observed in surgery rates, nonsurgical hospitalization r ates, the proportion of operations involving fusion, and the percentag e of surgical patients undergoing reoperation within 3 years. Wide cou nty variations suggest that there may be overutilization or underutili zation of low back pain treatments in some geographic areas. A more co nsistent approach to the management of back problems may benefit patie nts.