title: The impact of the evolution of invasive surgical procedures for low back pain: a population based study of patient outcomes and hospital utilization.
abstract: BACKGROUND
  Low back pain (LBP) is a ubiquitous health problem in Western societies, and while clinical decision making for patients requiring hospitalization for LBP has changed significantly over the past two decades, knowledge of the net impact on patient outcomes and health care utilization is lacking. The aim of this study was to evaluate the effectiveness of changes in the medical control of lumbar back pain in Western Australia in terms of the rate of patient readmission and the total bed days associated with readmissions.
  
  
  METHODS
  A record linkage population-based study of hospitalization for LBP from 1980-2003 in Western Australia was performed. The rate of admission for LBP, changes in re-admission rates and number of bed days accrued 1 and 3 years post-initial admission over time adjusted for potential confounders was evaluated.
  
  
  RESULTS
  The annual rate of first-time hospitalization for LBP halved. The proportion of females admitted increased (+6%). The disease severity increased and the proportion of individuals having an invasive procedure also increased (+75%) over the study period. While rate of readmission for non-invasive procedures fell, readmission for invasive procedures increased over the study period. Overall, the number of bed days associated with readmission reduced over time.
  
  
  CONCLUSIONS
  Between 1980 and 2003, there has been a shift from non-invasive procedural treatments towards invasive techniques both at the time of initial hospitalization and upon subsequent readmission. While overall readmission rates were unaffected, there was a reduction in the number of bed days associated with readmissions.
authors.affiliation: Australian Centre for Economic Research on Health (ACERH), School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia. Rachael.moorin@uwa.edu.au
authors.forename: Rachael Elizabeth
authors.initials: RE
authors.lastname: Moorin
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
mesh_terms: D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D017116:Low Back Pain / Q000453:epidemiology* / Q000601:surgery* / Q000628:therapy; D008297:Male; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D013123:Spinal Fusion; D016896:Treatment Outcome; D014904:Western Australia