Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA.
Neurosurgery. 2021 Nov 18;89(6):1062-1070. doi: 10.1093/neuros/nyab359.
Geriatric patients have the highest rates of Traumatic Brain Injury (TBI)-related hospitalization and death. This contributes to an assumption of futility in aggressive management in this population.
To evaluate the effect of surgical intervention on the morbidity and mortality of geriatric patients with TBI.
A retrospective analysis of patients ≥80 yr old with TBI from 2003 to 2016 was performed using the National Trauma Data Bank. Univariate and multivariate analyses were performed to compare outcomes between surgery and nonsurgery groups.
A total of 127 129 patient incidents were included: 121 185 (95.3%) without surgery and 5944 (4.7%) with surgery. The surgical group was slightly younger (84.0 vs 84.3, P < .001) and predominantly male (60.2% vs 44.4%, P < .001). Mean emergency department (ED) Glasgow Coma Scale (GCS) was lower in surgical patients (12.4 vs 13.7, P < .001). Complications (OR = 1.91, CI:1.80-2.02, P < .001) and hospital length of stay (LOS, ß = 5.25, CI:5.08-5.42, P < .001) were independently associated with surgery. Intensive care unit (ICU) LOS (ß = 3.19, CI:3.05-3.34, P < .001), ventilator days (ß = 1.57, CI:1.22-1.92, P < .001), and reduced discharge home (OR = 0.434, CI:0.400-0.470, P < .001) were also independently associated with surgery. However, surgery was not independently associated with mortality on multivariate analysis (OR = 1.03, CI:0.955-1.12, P = .423). Recursive partitioning analysis identified ED GCS and injury severity score (ISS) as prognosticators of mortality following surgical intervention.
Surgical treatment of geriatric patients with TBI is associated with increased complications, hospital LOS, ICU LOS, and ventilator days as well as reduced discharge to home. However, surgery is not associated with increased mortality. ISS and ED GCS are prognosticators of mortality following surgical intervention.
老年患者创伤性脑损伤（TBI）相关住院和死亡的比例最高。这导致人们认为在该人群中积极治疗是无效的。
评估手术干预对老年 TBI 患者发病率和死亡率的影响。
使用国家创伤数据库对 2003 年至 2016 年期间≥80 岁的 TBI 患者进行回顾性分析。对手术组和非手术组进行单变量和多变量分析，以比较两组的结局。
共纳入 127129 例患者事件：121185 例（95.3%）无手术，5944 例（4.7%）有手术。手术组患者年龄略小（84.0 岁 vs 84.3 岁，P<.001），男性比例更高（60.2% vs 44.4%，P<.001）。手术组患者急诊室（ED）格拉斯哥昏迷量表（GCS）评分较低（12.4 分 vs 13.7 分，P<.001）。并发症（比值比[OR]=1.91，95%置信区间[CI]：1.80-2.02，P<.001）和住院时间（LOS，β=5.25，95%CI：5.08-5.42，P<.001）与手术独立相关。重症监护病房（ICU）LOS（β=3.19，95%CI：3.05-3.34，P<.001）、呼吸机天数（β=1.57，95%CI：1.22-1.92，P<.001）和出院回家减少（OR=0.434，95%CI：0.400-0.470，P<.001）也与手术独立相关。然而，多变量分析显示手术与死亡率无独立相关性（OR=1.03，95%CI：0.955-1.12，P=0.423）。递归分区分析确定 ED GCS 和损伤严重程度评分（ISS）是手术干预后死亡率的预后因素。
对老年 TBI 患者进行手术治疗会增加并发症、住院时间、ICU 时间和呼吸机天数，并减少出院回家的可能性。然而，手术与死亡率增加无关。ISS 和 ED GCS 是手术干预后死亡率的预后因素。
