Nonsurgical hospitalization for low-back pain:Is it necessary?

In isaa, the Diagnosis-Related Group for "Medical Back Problems" was the seventh leading reason for all U.S. hnspitaItalians. Tho a uthors to jrjht to describe the content of these hospitalizations and consider the potential for shifting nonsurgical cere to the outpatient sotting. Three complementary data source* (the 1090 National Hospital Discharge Survey, a statewide Washington hospital discharge registry, and medical records) were used to examine the diagnoses, tests, treatments, resource use, and subsequent care associated with these hospitalizations. Nationally, nonspecific back pain and herniated diace were the most common diagnoses, Nearly half the hospitalizations were for diagnostic tests (especially myelography) and the other half For pain control. In Washington state, 43% of pstiente were admitted by family physicians cr internists, end 40% by orthopedic or neurologic surgeons. Twenty percent of patients underwent subsequent back surgery within 1 year trnost within 3 months), suggesting that many hospitalisations were "presurgical." Most of the tests and treatments Identified are known to be safe in the outpatient setting. Focused medical record review Indicated frequent psychosocial problems Or complicating factors, including obesity, substance abuse, prior back surgery, psychologic diagnoses, or lock of a caregiver at home. The findings support other evidence that many hospitalizations for "medical back problems" artr unnecessary, but also suggest a need for improved ouipBtlont and horno-basad alternatives to hospitalization.