ArticleOrthopedic research and reviews2026
Elevated Length of Stay and Cost of Orthopedic Hospitalization are Associated with Urban Setting, Non-Trauma Diagnosis, and Medicare Enrollment.
Article in Orthopedic research and reviews, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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3 authors.
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Abstract
Purpose: Disparities in orthopedic care delivery across hospital settings and payer types may significantly correlate with length of stay (LOS), cost burden, and care efficiency. This study quantifies the associations between geographic location, case acuity, insurance status and resource utilization in Michigan. Methods: We conducted a retrospective cohort study using 2018-2020 discharge records from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for Michigan. Orthopedic-related hospitalizations were identified and stratified by hospital location (urban vs rural), injury mechanism (trauma vs non-trauma), and primary payer (Medicare, Medicaid, private, other, uninsured). Outcomes included LOS, per-discharge cost, aggregate hospital-level expenditures, and population-adjusted discharge rates. Statistical comparisons were performed using two-sample t-tests and ANOVA. Independent associations were evaluated via mixed-effects regression models with hospital-level random intercepts. Results: Among 334,756 orthopedic discharges, urban facilities recorded longer average LOS (4.57 vs 4.09 days; P<0.001) and higher mean aggregate costs per hospital ($8.70M vs $1.74M; P<0.001) than rural counterparts. Non-traumatic cases were associated with greater per-stay costs ($19,645 vs $16,630; P<0.001). Uninsured patients experienced the longest LOS (4.70 days), followed by Medicare (4.35 days), Medicaid (3.89 days), private (3.72 days), and other (3.06 days; all P<0.001). Medicare accounted for the largest hospital-level expenditure ($3.28M mean; P<0.001). Mixed-effects models confirmed urban setting, non-trauma diagnosis, and Medicare enrollment as independent factors associated with elevated LOS and cost (P<0.001). Conclusion: Orthopedic care patterns demonstrate distinct variations linked to structural, clinical, and financial factors. These findings highlight disparities that may inform future discussions on reimbursement policies and rural capacity planning.
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