Authors: Robert Wagner Bina, MD; Sara Perotti; Travis Dumont, MD (Tucson, AZ)

Introduction: Prior studies have shown potential bias in the surgical treatment of traumatic brain injury patients without insurance. The Patient Protection and Affordable Care Act was passed in 2010. After the enactment of the PPACA, it is unknown if this potential bias persists. This study was undertaken to address this question. Methods: The Nationwide Inpatient Sample was queried for years 2012-2016. Patients with traumatic intracranial hemorrhage as the primary admitting diagnosis were isolated and compared for surgical treatment and survival relative to patient insurance status. A multivariate analysis including variables of patient gender, age by decade, admission severity score, and teaching hospital status was performed to compare outcome measures between years. Results: The percentage of uninsured patients declined from 11% to 4% during the queried timeframe. Overall, mortality was 11% for uninsured patients compared with 8% for insured patients. In multivariate analysis, uninsured status was associated with mortality in all years, p < 0.001.Multivariate regression analysis suggests an Odds Ratio of 0.82 for surgery in uninsured patients in 2012-2015 (p<0.001) and OR of 0.86 in 2016 (p<0.03). Conclusion: This analysis supports prior studies that uninsured patients were previously less likely to undergo surgery after admission for traumatic brain hemorrhage compared to insured patients; however, after the enactment of the PPACA, this gap seems to be diminishing. Despite this, mortality rates are higher in uninsured patients.