Age and Time as Predictors of Outcome in Patients Undergoing Decompressive Craniectomy for Traumatic Brain Injury

Abstract

Background: Evidence to support the benefit of decompressive craniectomy (DC) in traumatic brain injury (TBI) is diverging. Moreover, in the context of an aging population, there is a notable lack of direct evidence supporting the efficacy of DC in older age groups. In this study, we evaluate the impact of age on outcome after DC for TBI in a single-center cohort. Additionally, we explore the effect of time from injury to DC on outcome.

Methods: In this retrospective cohort study based on prospectively collected data from the Oslo TBI Registry Neurosurgery, we included TBI patients of any age admitted to Oslo University Hospital from 2015 to 2023 who had undergone DC. Dichotomized 6-month Glasgow Outcome Scale was analyzed for the whole cohort and stratified by patient age and time from TBI to DC in both univariable and multivariable analyses.

Results: Eighty-six patients were included. Median age was 41 years (range 2-79 years), and the median time from injury to DC was 7 hours (interquartile range 3-35 hours). Unfavorable outcome (Glasgow Outcome Scale 1-3) varied significantly according to both age group (≥60 years: 92%, 40-59 years: 67%, 20-39 years: 46%, and 0-19 years: 50%; P = 0.022) and whether the patient required early or later DC (DC ≤ 6 hours: 74%, DC > 6 hours: 50%; P = 0.023). In multivariable logistic regression, age (β 0.09, 95% confidence interval 0.03-0.14; P = 0.003) and time from injury to DC (β -0.02, 95% confidence interval -0.03 to 0.00; P = 0.02) remained associated with unfavorable outcome.

Conclusions: Older age and requiring DC earlier rather than later were associated with unfavorable outcomes after DC for TBI.

Keywords: Age; Decompressive craniectomy; Functional outcome; Mortality; Time; Traumatic brain injury.