Geographic Access to Musculoskeletal Surgical Care and Implications for Readiness in Active-Duty Service Members- MHSRS 2026

v pav, c colahan, g hileman, b hando, p pasquina, x yuan, b isaacson

Abstract accepted for poster presentation at the 2026 Military Health System Research Symposium (MHSRS)

INTRODUCTION: Musculoskeletal injuries (MSKIs) are the leading cause of limited duty and non-deployability across the Military Health System (MHS), yet variation in access to MSKI-related surgical care remains poorly defined. Delays related to travel distance, time from referral, and time away from duty may hinder recovery and return to duty. We developed a replicable framework to evaluate surgical distribution and travel burden among active duty service members (ADSMs). Shoulder instability was selected as a proof-of-concept condition due to its prevalence and impact on performance and readiness. We hypothesized that private sector care (PC) would be associated with greater travel distance than direct care (DC).

METHODS: MHS Data Repository (MDR) was used to identify ADSMs (<64 years) undergoing shoulder stabilization surgery during FY2024–2025 using CPT codes. Median [interquartile range] travel distance between residence and surgical location zip codes was calculated using the MDR drivetime file. Surgical volume and median travel distance were compared across DC, resource sharing (RS), and PC. Differences were assessed using Kruskal–Wallis and post-hoc Wilcoxon rank-sum tests with Bonferroni correction. 

RESULTS: Among 4,225 shoulder stabilization procedures, DC accounted for 51.6%, PC 35.0%, and RS 13.4%. The highest procedure volumes were observed in NC (13.18%; n=557), CA (12.76%; n=539), CO (9.14%, n=386), and TX (8.02%; n=339). Median travel distance differed significantly by setting (p<0.0001): DC (2.58 miles [0–22.41]), RS (12.15 miles [7.53–19.64]), and PC (23.13 miles [11.18–49.37]). Regional variation was substantial. High-volume states (e.g., CA, NC) showed low travel burden, while select PC markets had extreme distances (e.g., Houston, TX: 203.7 miles and Bismarck, ND 123.1 miles). Several DC facilities demonstrated zero-distance travel, indicating on-installation residence and care.

CONCLUSION: Shoulder stabilization surgery among ADSMs is delivered across a geographically variable system, with greater travel burden in PC. Increased travel may result in more time away from duty and delays in postoperative care, especially co-occurring with longer referral times, which are being added to the analysis. High-volume military regions may result in more efficient access, whereas selected regions rely on referral pathways. Optimizing access to surgical care may help accelerate recovery timelines for shoulder instability and other MSKIs.