title: Disparities in trauma: the impact of socioeconomic factors on outcomes following traumatic hollow viscus injury.
abstract: BACKGROUND
  This piece aims to examine the relationships between hollow viscus injury (HVI) and socioeconomic factors in determining outcomes. HVI has well-defined injury patterns with complex postoperative convalescence and morbidity, representing an ideal focus for identifying potential disparities among a homogeneous injury population.
  
  
  METHODS
  A retrospective review included patients admitted to a level I trauma center with HVI from 2000-2009, as identified in the Trauma Registry of the American College of Surgeons. Patients with concomitant significant solid organ or vasculature injury were excluded. US Census (2000) median household income by zip code was used as socioeconomic proxy. Demographic and injury-related variables were also included. Endpoints were mortality and outcomes associated with HVI morbidity.
  
  
  RESULTS
  A total of 933 patients with HVI were identified and 256 met inclusion criteria. There were 23 deaths (9.0%), and mortality was not associated with race, gender, income, or payer source. However, lower median household income was significantly associated with longer intervals to ostomy takedown (P = 0.032). Additionally, private payers had significantly lower rates of anastomotic leak (0% [0/73] versus 7.1% [13/183], P = 0.019) and fascial dehiscence (5.5% [4/73] versus 16.9% [31/183], P = 0.016), while self-payers had significantly higher rates of abscess formation, both overall (24% [24/100] versus 10.2% [16/156], P = 0.004) and among penetrating injuries (27.4% [23/84] versus 13.6% [12/88], P = 0.036).
  
  
  CONCLUSIONS
  Socioeconomic status may not impact overall mortality among trauma patients with hollow viscus injuries, but private insurance appears to be protective of morbidity related to anastomotic leak, fascial dehiscence, and abscess formation. This supports that socioeconomic disparity may exist within long-term outcomes, particularly regarding payer source.
authors.affiliation: Division of Trauma, Department of Surgery, Meharry Medical College, Nashville, Tennessee.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hazlitt
authors.affiliation: Division of Trauma, Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: J Bradford
authors.initials: JB
authors.lastname: Hill
authors.affiliation: Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Gunter
authors.affiliation: Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: oscar.guillamondegui@vanderbilt.edu.
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009017:Morbidity; D017063:Outcome Assessment, Health Care; D012042:Registries / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000601:surgery / Q000628:therapy
keywords: Blunt trauma; Critical care; Healthcare disparities; Hollow viscus injury; Payer status; Penetrating trauma; Trauma