Rural and Urban Hospitals Demonstrate Different Patterns of Declining Inpatient Arthroplasty Volume, 2013-2023
- 1Department of Orthopedic Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
- 2Corresponding author. 622 West 168th Street, New York, NY 10032, USA. Tel.: +1 917 957 6744.
Abstract
Background: Total joint arthroplasty has shifted rapidly from inpatient to outpatient settings. We evaluated whether inpatient Medicare arthroplasty volume changed differently across rural and urban hospitals from 2013 to 2023. Methods: Medicare Inpatient Hospitals—by Provider and Service files were analyzed. Hospitals with reportable Medicare Severity Diagnosis-Related Group 469/470 volume were classified as urban (Rural-Urban Commuting Area 1-3) or rural (Rural-Urban Commuting Area 4-10). A two-way fixed-effects model with hospital and year fixed effects assessed rural-urban differences in volume change using 2013 as reference. Persistence of reportable inpatient volume was evaluated among hospitals observed in 2013. Results: The cohort included 25,002 hospital-year observations across 2911 hospitals. The mean volume declined from 203 to 59 cases at urban hospitals and from 84 to 37 at rural hospitals between 2013 and 2023. Rural hospitals had greater relative declines before 2020, but the association reversed thereafter; rural × year difference-in-differences estimates were +63.4 cases in 2020, +104.2 in 2021, +118.3 in 2022, and +121.0 in 2023 (all P < .001), indicating smaller declines among rural hospitals remaining observable. However, by 2023, 73.3% of rural vs 46.4% of urban hospitals observed in 2013 were no longer reportable; rural status remained associated with loss after adjustment for baseline volume (odds ratio, 1.55; 95% confidence intervals, 1.24-1.93; P < .001). Conclusions: Inpatient arthroplasty declined substantially in both settings. Urban hospitals remaining observable experienced larger post-2020 volume declines, whereas rural hospitals were more likely to disappear from the reportable inpatient dataset. These patterns suggest different geographic manifestations of the national transition away from inpatient arthroplasty.
Related
- COPD/OSA phenotypes and inpatient outcome patterns among primary total hip arthroplasty hospitalizations: a national inpatient sample study, 2016–2022
- Mixed-Methods Analysis of a National Survey of Hospitals With Inpatient Hepatitis C Treatment Initiatives
- Total Hip Arthroplasty Is Associated With Lower 90-Day Inpatient Readmission Than Hemiarthroplasty for Femoral Neck Fracture in Patients Aged 65-75 Years: A Propensity Score-Matched Nationwide Readmissions Database Study
- Carer perceptions of inpatient psychiatric hospitals and the treatment of their loved ones: A meta-review of the literature
- Automated, Component-Level Assessment of a National Inpatient Diabetes Guideline: Adherence and Its Association with Hospitalization Complications Across Six Hospitals
BibTeX
@article{audreyrbyrne2026rural,
title = {{Rural and Urban Hospitals Demonstrate Different Patterns of Declining Inpatient Arthroplasty Volume, 2013-2023}},
author = {Audrey R. Byrne, BA and Krithi Pachipala, BA and Robert A. Cecere, MD and Lisa Y. Follett, DO and Nana O. Sarpong, MD, MBA},
journal = {Arthroplasty Today},
year = {2026},
month = oct,
doi = {10.1016/j.artd.2026.102198},
url = {https://doi.org/10.1016/j.artd.2026.102198},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Rural and Urban Hospitals Demonstrate Different Patterns of Declining Inpatient Arthroplasty Volume, 2013-2023
AU - Audrey R. Byrne, BA
AU - Krithi Pachipala, BA
AU - Robert A. Cecere, MD
AU - Lisa Y. Follett, DO
AU - Nana O. Sarpong, MD, MBA
PY - 2026
DA - 2026/10/28
JO - Arthroplasty Today
DO - 10.1016/j.artd.2026.102198
UR - https://doi.org/10.1016/j.artd.2026.102198
AB - Background: Total joint arthroplasty has shifted rapidly from inpatient to outpatient settings. We evaluated whether inpatient Medicare arthroplasty volume changed differently across rural and urban hospitals from 2013 to 2023. Methods: Medicare Inpatient Hospitals—by Provider and Service files were analyzed. Hospitals with reportable Medicare Severity Diagnosis-Related Group 469/470 volume were classified as urban (Rural-Urban Commuting Area 1-3) or rural (Rural-Urban Commuting Area 4-10). A two-way fixed-effects model with hospital and year fixed effects assessed rural-urban differences in volume change using 2013 as reference. Persistence of reportable inpatient volume was evaluated among hospitals observed in 2013. Results: The cohort included 25,002 hospital-year observations across 2911 hospitals. The mean volume declined from 203 to 59 cases at urban hospitals and from 84 to 37 at rural hospitals between 2013 and 2023. Rural hospitals had greater relative declines before 2020, but the association reversed thereafter; rural × year difference-in-differences estimates were +63.4 cases in 2020, +104.2 in 2021, +118.3 in 2022, and +121.0 in 2023 (all P < .001), indicating smaller declines among rural hospitals remaining observable. However, by 2023, 73.3% of rural vs 46.4% of urban hospitals observed in 2013 were no longer reportable; rural status remained associated with loss after adjustment for baseline volume (odds ratio, 1.55; 95% confidence intervals, 1.24-1.93; P < .001). Conclusions: Inpatient arthroplasty declined substantially in both settings. Urban hospitals remaining observable experienced larger post-2020 volume declines, whereas rural hospitals were more likely to disappear from the reportable inpatient dataset. These patterns suggest different geographic manifestations of the national transition away from inpatient arthroplasty.
SN - 2352-3441
ER -