Comparative Epidemiological Study of Orthopedic Conditions in Michigan

Introduction

Variations in orthopedic care between urban and rural hospitals may influence length of stay (LOS), costs, and resource utilization. Yet the extent and nature of these differences remain poorly characterized. Understanding how hospital location, injury type, and insurance coverage influence length of stay and expenditures is essential. These factors play a crucial role in healthcare resource allocation and patient outcomes.

Methods

A retrospective cohort analysis was conducted using 2018–2020 discharge records from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP) database. Inclusion criteria was orthopedic-related diagnoses from Michigan hospitals. Hospitalizations were classified by location (urban vs rural), trauma status (trauma vs non-trauma), and insurance type (Medicare, Medicaid, private, other, uninsured). Length of stay, per-stay and aggregate hospital costs, and discharge rates were recorded. Multivariable t-tests, ANOVA, and a mixed-effects model analysis were conducted to compare differences across the variables.

Results

Among 334,756 orthopedic discharges, urban hospitals had a longer mean LOS than rural hospitals (4.57 vs 4.09 days; P<.001). Non-trauma cases incurred higher per-stay costs than trauma cases ($19,645 vs $16,630; P<.001). Uninsured patients had the longest mean Length of Stay (LOS) (4.70 days), followed by Medicare (4.35 days), Medicaid (3.89 days), private insurance (3.72 days), and other insurance (3.06 days). All differences were statistically significant (P < .001). Aggregate expenditures were highest for Medicare ($3.3M; P<.001), and urban hospitals showed greater overall spending across all insurance groups. Medicaid had higher per- stay costs than uninsured ($18,745 vs $15,892; P=.03) but lower total expenditures. Rural hospitals reported higher per-stay trauma costs ($16,659 vs $16,509; P=.88) but lower total expenditures ($1.08M vs $7.44M; P<.001), whereas urban non-trauma cases had the highest total expenditures ($9.68M; P<.001). In a mixed-effects analysis, urban location, non-trauma status, and Medicare coverage were independently associated with increased LOS and hospital costs (P<.001).

Conclusion

Orthopedic care differences reflect variations in hospital infrastructure, case complexity, and reimbursement models. Urban hospitals often face higher costs, driven partly by Medicare-heavy admissions and resource-intensive non-trauma cases. Rural hospitals operate with tighter budgets, even though their per-stay trauma costs are similar to those in urban hospitals. Insurance- related cost fluctuations expose gaps in current reimbursement structures. Aligning payments with actual hospital burdens and investing in rural healthcare systems may help address these challenges.