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BACKGROUND Posthospitalization care is important for recovery after trauma. Disadvantaged populations, like racial or ethnic minorities and the uninsured, make up substantial percentages of trauma patients, but their use of posthospitalization facilities is unknown. STUDY DESIGN This study analyzed National Trauma Data Bank admissions from 2007 for 18- to 64-year-olds and estimated relative risk ratios (RRR) of discharge to posthospitalization facilities—home, home health, rehabilitation, or nursing facility—by race, ethnicity, and insurance. Multinomial logistic regression adjusted for patient characteristics including age, sex, Injury Severity Score, mechanism of injury, and length of stay, among others. RESULTS There were 136,239 patients who met inclusion criteria with data for analysis. Most patients were discharged home (78.9%); fewer went to home health (3.3%), rehabilitation (5.0%), and nursing facilities (5.4%). When compared with white patients in adjusted analysis, relative risk ratios of discharge to rehabilitation were 0.61 (95% CI 0.56, 0.66) and 0.44 (95% CI 0.40, 0.49) for blacks and Hispanics, respectively. Compared with privately insured white patients, Hispanics had lower rates of discharge to rehabilitation whether privately insured (RRR 0.45, 95% CI 0.40, 0.52), publicly insured (RRR 0.51, 95% CI 0.42, 0.61), or uninsured (RRR 0.20, 95% CI 0.17, 0.24). Black patients had similarly low rates: private (RRR 0.63, 95% CI 0.56, 0.71), public (RRR 0.72, 95% CI 0.63, 0.82), or uninsured (RRR 0.27, 95% CI 0.23, 0.32). Relative risk ratios of discharge to home health or nursing facilities showed similar trends among blacks and Hispanics regardless of insurance, except for black patients with insurance whose discharge to nursing facilities was similar to their white counterparts. CONCLUSIONS Disadvantaged populations have more limited use of posthospitalization care such as rehabilitation after trauma, suggesting a potential improvement in trauma care for the underprivileged.

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Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient's ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes.

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ulcerative colitis at our institution from 2000 2007 was performed. Obese patients were defined as those patients with body mass index (BMI) greater than or equal to 30 kg/m 2 (Group 1). Control patients were defined as having a BMI less 30 kg/m 2 (Group 2). Significant dif ferences between continuous and categorical variables were identified using the Wilcoxon rank sum and Chi square tests, respectively. Oper ative approach and time, blood loss, type of anastomosis and mucosal length were used as measures of surgical complexity. Length of hospi tal stay and complications including wound infection, ileus and stric ture were evaluated. Pre and postoperative manometry and quality of life measures were analyzed in both groups. Results: A total of 313 patients underwent RPC for ulcerative colitis in the time period of the study. Of this total, 42 patients were in Group 1 (BMI greater than or equal to 30 kg/m 2 ) and 139 patients were in Group 2 (BMI less than 30 kg/m 2 ). The average BMI was 34.7 kg/m 2 (range 30.1 90.8) and 24.3 kg/m 2 (range 17.6 29.9) in Groups 1 and 2, respectively. All patients in this series underwent the planned operation of a RPC with ileal S pouch construction. A laparoscopic approach was under taken more frequently in Group 2 (45% v. 9.5%, p value 0.001). A hand sewn anastomosis was used less often than other anastomotic techniques in the obese patients (11.9% v. 32.4%), resulting in longer mucosal remnants (1.4 cm v. 1.1 cm) which was significantly signifi cant (p value 0.012). No difference in operative times or blood loss between the two groups was found. Additionally, the two groups did not demonstrate any difference between length of hospital stay or rate of complications. Postoperative manometry was not statistically significant between groups (p values < 0.05). Both groups demon strated significant increases in quality of life measures (p val ues < 0.05) with no differences between groups. Conclusions: We have hypothesized that restorative proctocolectomy can be performed safely and successfully in the obese. In our series, obesity did not re duce the rate of successful completion of a RPC as measured by quality of life and manometry studies, and did not adversely affect complica tion rates. Not surprisingly, the obese patients were less likely to have a hand sewn anastomosis and more likely to have a longer muco sal remnant. These data have led us to conclude obesity is not a contra indication to successful RPC in patients with ulcerative colitis.Introduction: Laparoscopic appendectomy (LA) has been an estab lished treatment method for uncomplicated acute appendicitis for twenty years. Controversy still exists regarding the superiority of ei ther technique for the treatment of complicated appendicitis. Objective: To examine and elucidate any benefits in post operative morbidity and mortality when comparing laparoscopic versus open appendectomy for complicated appendicitis. Method and Design of Study: A retrospective analysis was performed using the American College of Surgeon's Nati...