Distribution and Cost Profile of Orthopedic Surgical Services at a Rural Province Hospital in Nepal: An Observational Study

Abstract

Introduction: Musculoskeletal conditions are an important cause of disability in Nepal, particularly in rural settings where financial and structural constraints limit timely access to orthopedic surgical care. The distribution and cost profile of orthopedic surgeries at rural hospitals are essential for service planning and resource allocation in such settings.

Methods: A retrospective descriptive study was conducted at Province Hospital Gorkha among all patients who underwent orthopedic surgery. A total of 700 consecutive cases were included. Data on patient demographics, diagnosis, type of surgery, anesthesia, implant use, mode of payment, and surgical cost were extracted from hospital records and analyzed using descriptive statistical methods using SPSS version 26.

Results: A total of 700 consecutive orthopedic surgeries were analyzed. Patients ranged from 1 to 92 years of mean age of (37.0±22.9 years); 427 (61.00%) were male and 340 (48.57%) were aged 18–59 years. Trauma-related conditions accounted for most surgeries, and implant-related procedures comprised 472 (67.43%) of cases. Regional anesthesia techniques were used in 583 (83.29%) cases. Out-of-pocket (cash) payment was seen in 304 (43.43%) cases, health insurance in 257 (36.71%), and extended health services in 133 (19%). Mean surgical costs were lowest among cash-paying patients (NPR 7,227; USD 51.62) and highest among those covered by health insurance (NPR 12,888; USD 92.06).

Conclusions: Orthopedic surgical care at this rural province hospital was largely trauma-related and delivered at relatively low cost; however, out-of-pocket payment remained common. Health insurance coverage was observed more frequently among patients undergoing complex, implant-based, and elective procedures.