Decompressive Craniectomy is Associated with Improved Quality of Life Up to Ten Years After Rehabilitation from Traumatic Brain Injury

Abstract

Background: Traumatic brain injury (TBI) is the number one cause of death in children and young adults and has become increasingly prevalent in the elderly. Decompressive craniectomy (DC) prevents intracranial hypertension but does not clearly improve physical outcome at 6 months after TBI. However, if DC affects TBI patients´ quality of life in the long term, has not been analysed. Therefore, we conducted a cross-sectional study assessing health-related QoL (HRQoL) in TBI patients with or without DC up to ten years after injury. Methods: Craniectomized (DC+; n=41) and non-craniectomized (DC-; n=94) TBI patients answered the TBI-specific QOLIBRI questionnaire up to ten years after neuro44 rehabilitation with a QOLIBRI total score from zero to 100, representing lowest and best HRQoL, respectively. HRQoL was correlated to TBI severity, aetiology, age at TBI, age at survey, sex, decompressive craniectomy, tracheostomy, and ICP monitoring using multivariate regression. Findings: QOLIBRI total scores were significantly higher in DC+ vs. DC- TBI patients (76 vs. 65, respectively; p=0·049, adj. R2 =0·07). Improved HRQoL was most significantly associated with initially mild TBI (p=0·001, adj. R2 =0·45) and older age at admission (61-85 years; p=0·02). QOLIBRI questions addressing physical abilities were not different between groups. Interpretation: Our results suggest that DC is associated with better HRQoL up to ten years after TBI. Thus, DC may have a beneficial, but so far underestimated therapeutic potential after TBI. Funding Statement: The current study did not receive any third-party funds. Declaration of Interests: No competing financial interests exist. Ethics Approval Statement: According to local legislation (BayKrG) and the ethical committee of the Ludwig-Maximilians University, Munich, Germany, ethics approval was not required for this study.