Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery: A TRACK-TBI Study

Area of Science:

• Neuroscience
• Trauma Surgery
• Clinical Outcomes

Background:

• Traumatic brain injury (TBI) can lead to lasting cognitive and functional deficits.
• Secondary insults, such as surgery and anesthesia, may exacerbate TBI-related impairments.
• Previous research suggests a link between surgery and neurocognitive disorders.

Purpose of the Study:

• To investigate the association between extracranial (EC) surgery and anesthesia exposure and outcomes following TBI.
• To determine if EC surgery impacts functional and cognitive recovery in TBI patients.

Main Methods:

• Retrospective analysis of the TRACK-TBI study data (18 US trauma centers, Feb 2014 - Aug 2018).
• Inclusion criteria: age ≥17, TBI diagnosis, inpatient admission, known GCS and CT status, no cranial surgery.
• Comparison of patients who underwent EC surgery versus those who did not, stratified by TBI severity (mild, moderate, severe).

Main Results:

• 1835 participants analyzed (1349 non-surgical, 486 surgical).
• EC surgery was associated with significantly worse Glasgow Outcome Scale-Extended (GOSE-ALL) scores at 2 weeks and 6 months post-injury.
• At 6 months, patients with moderate-to-severe TBI (m/sTBI) or complicated mild TBI (CT+ mTBI) who had EC surgery showed poorer functional (GOSE-TBI) and cognitive (Trail Making Test Part B) outcomes.

Conclusions:

• Exposure to EC surgery and anesthesia following TBI is associated with adverse functional outcomes and impaired executive function.
• These findings highlight the need for further investigation into the mechanisms and clinical implications.
• The results may inform decisions regarding the timing of surgical interventions in TBI patients.