Healthcare Burden


Lead Author(s): 

Jaimo Ahn, MD, PhD, FACS
Arvind D Nana, MD
Gudrun Mirick, MD
Anna N Miller, MD, FACS

Supporting Author(s): 

Sylvia I Watkins-Castillo, PhD

Chapter Supporter: 

Length of Stay and Hospital Charges

The average hospital length of stay for musculoskeletal injuries in 2013 was 5.4 days, nearly a full day longer than for hospital discharges for any diagnoses (4.6 days). Persons age 45 to 64 had a slightly longer average stay (5.6 days), while those under 18 years of age had the shortest stay (4.3 days).

Dislocation injuries serious enough to require hospitalization had the longest average length of stay in 2013, nearly six days. However, except for serious sprains and strain injuries, with an average stay of just under five days (4.8), all musculoskeletal injuries had an average hospital stay of five to five-and-one-half days. 

Average charges to treat musculoskeletal injuries provide a comparison between injury type and groups, but do not necessarily reflect actual cost as these are usually negotiated between providers and payors. By age, the highest average charges are for persons age 18 to 44 years ($64,700 per stay). The lowest charges are for the youngest patients (under 18 years, $47,400) and those age 65 and over ($51,000). By type of injury, dislocations have the highest average charges ($74,000 per episode), followed by fractions ($61,900). Musculoskeletal injuries have average hospital charges of $15,000 more than hospital stays for any diagnoses ($55,700 vs. $39,500).  (Reference Table 5B.4.1.2 PDF CSV)

In general, the average length of stay and average charges for persons hospitalized with a musculoskeletal injury are longer/higher for men than for women, with the exceptions of fractures and contusions. Overall, non-Hispanic blacks have slightly longer hospital stays for musculoskeletal injuries, while Hispanics have higher average charges. By geographic region, the Northeast and South have slightly longer average stays, but the highest average charges are in the West. Fractures account for more than half the total charges for musculoskeletal injuries. (Reference Table 5B.4.1.1 PDF CSV; Reference Table 5B.4.1.3 PDF CSV; Reference Table 5B.4.1.4 PDF CSV)

Total charges for all persons hospitalized with a musculoskeletal injury diagnoses (6.3%) comprise a larger share of total hospital charges for all discharges with any diagnoses than the comparative share of patients (4.5%). The discrepancy from 0.5% to 4.1% and is greatest for persons age 45 to 64. (Reference Table 5B.4.1.1 PDF CSV; Reference Table 5B.4.1.2 PDF CSV; Reference Table 5B.4.1.3 PDF CSV; Reference Table 5B.4.1.4 PDF CSV)


Musculoskeletal injuries treated in an emergency department (ED) are usually discharged to home (90%), but nearly one in ten is admitted to the hospital (8%). This is half the rate seen for all other diagnoses presenting to the ED (16%). However, persons treated in a hospital for a musculoskeletal injury are more likely to be discharged to additional care (55%), including short-term, skilled nursing/intermediate care, or home health care, than are hospital discharges for any diagnoses (30%). (Reference Table 5B.4.2 PDF CSV;  Table 5B.4.3 PDF CSV)

The type of musculoskeletal injury impacts whether additional care is likely to be required, with fracture injuries more often discharged to additional care than other types of musculoskeletal injuries. One in for (25%) of persons with fracture injuries seen in the ED are admitted to the hospital.

Age is a significant factor related to additional care.  Among those under the age of 18, 91% are discharged from the hospital to home. By the age of 65 and over, 81% are discharged to skilled nursing/intermediate care or home health care with a fracture. This compares to 25% of hospital discharges for any diagnoses.



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