Predictors of seizures in postoperative traumatic brain injury patients: A single center retrospective study

Seizures are common postoperative complications for patients who have undergone surgical management for traumatic brain injury (TBI). However, little is known regarding preoperative factors that predict them. This study aims to describe preoperative factors that influence the occurrence of seizures after surgery for TBI.

A retrospective study of all operative TBI patients between 2012 and 2021 was performed. Individuals with TBI that received medical management only were excluded. The presence of postoperative seizures was determined according to documentation in the medical record of seizures after the date of surgery for TBI. Individuals who had documented seizures pre-TBI were excluded from the analysis. Univariate comparisons and multivariate logistic regression were performed.

200 individuals were included in this study. Forty-six individuals (24.96 %) experienced at least one documented postoperative seizure within one week of surgery. Of those, 97.5 % were on Levetiracetam prophylactic coverage. Factors associated with postoperative seizures included age ≥ 60 years (p = .045) and smoking history (p = .048). A trend towards significance was seen in individuals whose injuries included subdural hematomas (p = .086), as well as those with a history of diabetes (p = .053). There were no differences according to initial GCS at presentation (p = .54), presence of EDH (p = .83), IPH (p = .75), SAH/IVH (p = .51), midline shift (p = .114), procedure type (p = .52) (craniotomy or craniectomy). SDH presence (OR 4.39 CI95 % 1.33 - 14.50) and former smoking status (OR 3.49 CI95 % 1.31 - 9.16) were significant risk factors on multivariate analysis when controlling for age, diabetes, and current smoking history. Former smoking remained significant in patients experiencing siezures greater than 7 days post-surgery as well (OR 4.56; CI 95 % 1.13-18.27).

In postoperative TBI patients, former smokers and the presence of SDH significantly increase the risk of experiencing seizures even while on prophylactic ASMs. These factors should be considered when managing postoperative TBI patients.