Extracranial (EC) surgery and anesthesia soon after a traumatic brain injury (TBI) are associated with poorer functional and cognitive outcomes, new research shows.
Patients with TBI had worse functional recovery and poorer neurocognitive outcomes across all TBI severities at 2 weeks and 6 months compared with their counterparts who did not undergo surgery.
Those with moderate to severe TBI (m/sTBI) and those with complicated mild TBI and positive results on CT (CT+ mTBI) reported the worst outcomes.
“These findings support the hypothesis that surgery and anesthesia, or alternatively multiple trauma, might need to be included in the list of secondary insults to be avoided, if possible, to protect the brain after TBI,” lead investigator, Christopher J. Roberts, MD, PhD, from the Department of Anesthesiology at the Medical College of Wisconsin and at Zablocki Veterans Affairs Medical Center, Milwaukee, and coauthors write.
The findings were published online December 13 in JAMA Surgery.
Impact on Recovery
For the retrospective study, investigators examined data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study, a prospective cohort longitudinal study conducted at 18 Level I US trauma centers between 2014 and 2018.
The study included 1835 patients (mean age, 42 years; 70% male) in this secondary analysis, all of whom were seen within 24 hours of the TBI and had had no cranial surgery for TBI at baseline.
EC surgery was performed on 486 patients during the study period, mostly for extremity fracture.
Functional recovery from TBI was measured with the Glasgow Outcome Scale–Extended for all injuries (GOSE-ALL) and specifically for brain injury (GOSE-TBI). Neurocognitive outcomes were measured with the Trail Making Test Parts A and B.
Those who underwent EC surgery had significantly worse functional recovery and neurocognitive outcomes at 2 weeks and 6 months compared with the nonsurgical group, regardless of TBI severity. The worst outcomes were found in patients with m/sTBI (P
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