Association Between Operative Neurosurgical Intervention and Favorable Discharge Among Patients With Traumatic...

Area of Science:

• Neurosurgery
• Trauma Care
• Clinical Outcomes Research

Background:

• Traumatic subdural hematoma (SDH) with poor neurological presentation often leads to adverse outcomes.
• Limited research exists on the impact of operative neurosurgery in this patient group.
• This study addresses the association between surgical intervention and favorable outcomes.

Purpose of the Study:

• To determine if operative neurosurgery is linked to favorable discharge in patients with traumatic SDH and poor neurological presentation.
• To analyze the influence of pupillary response and age on this association.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Programs Dataset.
• Included 13,393 adult patients with traumatic SDH, significant midline shift (>5 mm), and low Glasgow Coma Scale (≤8).
• Employed risk-adjusted hierarchical regression models and evaluated effect modification by pupillary response.

Main Results:

• Operative neurosurgery was associated with a higher likelihood of favorable discharge (OR, 1.93; 95% CI, 1.74-2.14).
• The association was significantly modified by pupillary response, with the greatest benefit for patients with non-reactive pupils (0R).
• Potential benefits were observed across age groups but diminished in patients over 75 years.

Conclusions:

• Operative neurosurgical intervention is associated with favorable discharge in patients with traumatic SDH and poor neurological presentation.
• This association holds across different pupillary responses and age groups.
• The potential benefit of surgery is reduced in the oldest patient subgroup (>75 years).