Predictors of 30-Day Mortality in Traumatic Brain-Injured Patients after Primary Decompressive Craniectomy

Abstract

Primary decompressive craniectomy (DC) is an important therapeutic technique for severe head-injured patients with space-occupying lesions in emergency situations, but these patients are still at high risk for unfavorable outcomes. This study aimed to investigate the predictors of 30-day mortality in adult patients undergoing primary DC after traumatic brain injury (TBI). All adult patients (≥18 years of age) who underwent primary DC from January 2012 to March 2019 were included. Demographic, clinical, surgical, and laboratory variables were collected for analysis. Early mortality was defined as 30-day mortality after DC. First, a univariate analysis (P < 0.05) was used to compare survivors and nonsurvivors. Multivariate logistic regression analysis was used to identify the predictors of 30-day mortality for patients who underwent primary DC. A total of 387 patients were enrolled in the study. The 30-day mortality was 31.52% (122/387). The median age at presentation was 49 years (interquartile range, 38-60), and 316 (81.65%) patients were male. In the multivariate logistic regression analysis, the factors associated with 30-day mortality included age (odds ratio [OR], 1.068; 95% confidence interval [CI], 1.040-1.096; P < 0.001), bilateral unreactive pupils (OR, 12.734; 95% CI, 4.129-39.270; P < 0.001), subdural hemorrhage (OR, 3.468; 95% CI, 1.305-9.218; P < 0.013), completely effaced basal cistern (OR, 3.52; 95% CI, 1.568-7.901; P= 0.002), intraoperative hypotension (OR, 11.532; 95% CI, 4.222-31.499; P < 0.001), preoperative activated partial thromboplastin time (OR, 6.905; 95% CI, 2.055-23.202; P= 0.002), and Injury Severity Score (OR, 1.081; 95% CI, 1.031-1.133; P= 0.002). In patients undergoing primary DC after traumatic brain injury, the predictors of 30-day mortality include age, bilateral unreactive pupils, subdural hemorrhage, completely effaced basal cistern, intraoperative hypotension, preoperative activated partial thromboplastin time, and Injury Severity Score.