Intracranial Gunshot Wounds: An Assessment of Patient Characteristics on Surgical Outcomes

Intracranial gunshot wounds (GSW) are often fatal, with most patients dying before intervention can occur. Surgical management, when indicated, results in decreased mortality. We sought to assess the neurosurgical outcomes and economic costs of intracranial GSW.

We conducted a retrospective analysis using the longitudinal claims Truven MarketScan® database (IBM) from 2000 to 2016. Mortality was the primary outcome of interest. Complications, length of stay, and payment were secondary outcomes. Multivariable logistic and linear regression analyses were performed to assess the relationship between age, gender, insurance type, and the number of comorbidities in the outcomes measured.

We identified 315 patients (median age 34.0 years; interquartile range (IQR)=24, 48; 32.06% female) who received craniotomy or craniectomy for intracranial GSW. Mortality occurred in 44 patients (13.97%) and 234 patients (74.29%) experienced complications. The median length of stay was 13 days (IQR=5, 25 days), and the median cost was $70,624.00 (IQR=$32,378.00; $163,437.00). Increases in the Elixhauser index by one-comorbidity increments were associated with increased length of stay (risk ratio (RR)=1.207; 95% confidence interval (CI)=1.106-1.317) and payment (RR=1.135; 95% CI=1.036-1.243). Patients with respiratory complications, excluding infection, experienced an increased risk of mortality (odds ratio (OR)=3.486; 95% CI=1.623-7.485), length of stay (RR=1.649; 95% CI=1.321-2.060), and payment (RR=2.085; 95% CI=1.652-2.631).

Although these findings must be interpreted in the context of the limitations inherent to studies using national administrative data, the current study provides additional insight into the relationship between patient characteristics and outcomes after surgery for intracranial GSW.