Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery

Abstract

ImportanceTraumatic brain injury (TBI) is associated with persistent functional and cognitive deficits, which may be susceptible to secondary insults. The implications of exposure to surgery and anesthesia after TBI warrant investigation, given that surgery has been associated with neurocognitive disorders.ObjectiveTo examine whether exposure to extracranial (EC) surgery and anesthesia is related to worse functional and cognitive outcomes after TBI.Design, Setting, and ParticipantsThis study was a retrospective, secondary analysis of data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a prospective cohort study that assessed longitudinal outcomes of participants enrolled at 18 level I US trauma centers between February 1, 2014, and August 31, 2018. Participants were 17 years or older, presented within 24 hours of trauma, were admitted to an inpatient unit from the emergency department, had known Glasgow Coma Scale (GCS) and head computed tomography (CT) status, and did not undergo cranial surgery. This analysis was conducted between January 2, 2020, and August 8, 2023.ExposureParticipants who underwent EC surgery during the index admission were compared with participants with no surgery in groups with a peripheral orthopedic injury or a TBI and were classified as having uncomplicated mild TBI (GCS score of 13-15 and negative CT results [CT− mTBI]), complicated mild TBI (GCS score of 13-15 and positive CT results [CT+ mTBI]), or moderate to severe TBI (GCS score of 3-12 [m/sTBI]).Main Outcomes and MeasuresThe primary outcomes were functional limitations quantified by the Glasgow Outcome Scale–Extended for all injuries (GOSE-ALL) and brain injury (GOSE-TBI) and neurocognitive outcomes at 2 weeks and 6 months after injury.ResultsA total of 1835 participants (mean [SD] age, 42.2 [17.8] years; 1279 [70%] male; 299 Black, 1412 White, and 96 other) were analyzed, including 1349 nonsurgical participants and 486 participants undergoing EC surgery. The participants undergoing EC surgery across all TBI severities had significantly worse GOSE-ALL scores at 2 weeks and 6 months compared with their nonsurgical counterparts. At 6 months after injury, m/sTBI and CT+ mTBI participants who underwent EC surgery had significantly worse GOSE-TBI scores (B = −1.11 [95% CI, −1.53 to −0.68] in participants with m/sTBI and −0.39 [95% CI, −0.77 to −0.01] in participants with CT+ mTBI) and performed worse on the Trail Making Test Part B (B = 30.1 [95% CI, 11.9-48.2] in participants with m/sTBI and 26.3 [95% CI, 11.3-41.2] in participants with CT+ mTBI).Conclusions and RelevanceThis study found that exposure to EC surgery and anesthesia was associated with adverse functional outcomes and impaired executive function after TBI. This unfavorable association warrants further investigation of the potential mechanisms and clinical implications that could inform decisions regarding the timing of surgical interventions in patients after TBI.

Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury

“…However, it is difficult to disentangle the effects of systemic injuries from those of brain injuries in clinical practice. 27 Roberts et al 28 found a correlation between extracranial surgery and anesthesia with adverse functional outcomes and impaired executive function following TBI. Nevertheless, it is vital to identify patients with lower extremity injuries and ensure that proper treatment options are available, regardless of the time of injury.…”

“… 29 Other factors such as surgical urgency, 30 insults introduced intraoperatively or during transportation, and other factors that may affect the results were not considered in our analysis. 28 Patients with severe TBI (GCS score <8) are more likely to experience secondary insults (eg, hypotension, intraoperative bleeding, hypoxia, hyperventilation, and increase in ICP) due to lying flat on the operating table; these patients are least likely to benefit from early ambulation and shorter bed rest. For patients with moderate to severe TBI, early fixation may increase the risk of secondary insult, suggesting that there is no need to expedite extremity fracture fixation.…”

Prediction Value of Initial Serum Levels of SERPINA3 in Intracranial Pressure and Long-Term Neurological Outcomes in Traumatic Brain Injury

“…The initial severity of TBI was usually classified as mild, moderate, or severe based on the clinical awareness level of the Glasgow Coma Scale (GCS) [ 5 ]. The GCS score, together with age, computed tomography (CT) findings, hypoxia, and systolic blood pressure are the significant factors affecting the prognosis [ 6 , 7 , 8 ].…”

Surgery induces neurocognitive disorder via neuroinflammation and glymphatic dysfunction in middle-aged mice with brain lymphatic drainage impairment

“…Aging and neurodegenerative related diseases, such as Alzheimer's disease (AD) and some cerebrovascular diseases, exhibit increased vulnerability to postoperative neurocognitive disorders (PND), which affects millions of surgical patients every year (Silbert et al, 2015;Li et al, 2021;Sun et al, 2021;Roberts et al, 2024). PND is characterized by a surgery-induced deterioration in cognitive function, including memory impairment, attention deficits, and other cognitive domain impairments.…”