Impact of Extracranial Surgery and Anesthesia on Clinical Outcomes after Traumatic Brain Injury: TRACK-TBI Study

Introduction

Traumatic brain injury (TBI) is known to result in long-term functional and cognitive deficits. However, the influence of exposure to surgery and anesthesia on TBI outcomes remains uncertain, despite previous associations between surgery and neurocognitive disorders. The purpose of this retrospective cohort study was to investigate whether extracranial (EC) surgery and anesthesia are linked to worse functional and cognitive outcomes following TBI.

Methods

The study analyzed data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, which included participants from 18 level I trauma centers in the United States. The participants were 17 years or older, presented within 24 hours of trauma, were admitted from the emergency department, and had known Glasgow Coma Scale (GCS) and head computed tomography (CT) results. Participants who underwent cranial surgery were excluded from the analysis. The outcomes assessed were functional limitations measured by the Glasgow Outcome Scale “Extended for all injuries (GOSE-ALL) and brain injury (GOSE-TBI), as well as neurocognitive outcomes at 2 weeks and 6 months post-injury.

Results

A total of 1835 participants were analyzed, comprising 1349 nonsurgical participants and 486 participants who underwent EC surgery. The study found that participants who underwent EC surgery had significantly worse functional outcomes at both 2 weeks and 6 months after injury, compared to their nonsurgical counterparts. At 6 months, participants with moderate to severe TBI (m/sTBI) and positive CT results for mild TBI (CT+ mTBI) who underwent EC surgery had significantly worse GOSE-TBI scores and performed worse on the Trail Making Test Part B, indicating impaired executive function.

Conclusions

The study revealed an association between exposure to EC surgery and anesthesia and unfavorable functional and cognitive outcomes after TBI, particularly in individuals with acute intracranial findings on neuroimaging. These findings highlight the potential detrimental effects of the perioperative period on the injured brain. Further investigation is warranted to determine the underlying mechanisms and clinical implications, which could inform decisions regarding the timing of surgical interventions in TBI patients.