Surgical Versus Medical Management in Older Adults with Traumatic Brain Injury: A Systematic Review and Meta-analysis

Area of Science:

• Geriatric Medicine
• Neurosurgery
• Critical Care Medicine

Background:

• Traumatic brain injury (TBI) in older adults presents significant mortality and functional challenges.
• Optimal management strategies for TBI in this demographic are unclear due to limited evidence.
• Existing data often extrapolates from younger populations, necessitating specific research.

Purpose of the Study:

• To systematically review and meta-analyze outcomes comparing surgical versus medical management for TBI in older adults (≥60 years).
• To assess the impact of surgical intervention on neurological outcomes, hospital length of stay (LOS), and mortality.

Main Methods:

• A comprehensive search of PubMed, Embase, and Web of Science was conducted up to December 8, 2025.
• Included studies were cohort studies comparing surgical and medical management in adults aged 60 years and older with TBI.
• Pooled estimates for favorable neurological outcome, LOS, and mortality were calculated using random-effects models.

Main Results:

• Analysis of 16 cohort studies (132,823 patients) revealed no improvement in favorable neurological outcomes with surgical management.
• Surgical intervention was associated with a significantly longer hospital LOS (MD = 6.35 days).
• A notable reduction in 6-month mortality was observed with surgical management (RR = 0.68), though overall mortality rates showed no significant difference.

Conclusions:

• Surgical management in older adults with TBI is linked to reduced 6-month mortality and increased hospital LOS, but not improved functional recovery.
• A dissociation between survival benefits and functional outcomes exists, impacting clinical decision-making and patient counseling.
• High-quality randomized controlled trials are essential to clarify the role of surgery in this patient population, given the current low-to-very-low certainty of evidence.