Faculty Collaboration Database

Timing of surgery after multisystem injury with traumatic brain injury: effect on neuropsychological and functional outcome. J Trauma 2007 May;62(5):1250-8

Date

05/15/2007

Pubmed ID

17495732

DOI

10.1097/01.ta.0000215581.50234.56

Scopus ID

2-s2.0-34248358673 (requires institutional sign-in at Scopus site)   32 Citations

Abstract

OBJECTIVE: The optimal timing for noncranial surgery after multisystem injury is not known. Early surgery may lead to decreased pulmonary complications and length of stay, but also predispose to secondary brain injury if decreased cerebral perfusion occurs intraoperatively. Previous work has not consistently evaluated neuropsychological or functional outcome. We sought to determine whether 6-month neuropsychological and functional outcome was associated with timing of noncranial surgery after traumatic brain injury.

MATERIALS: We performed a cohort study to evaluate the effect of timing of non-neurosurgical operative interventions on neuropsychological and functional outcome, morbidity, and mortality. Early surgery was defined as <or=24 hours after injury, and late surgery, >24 hours after injury but during the same admission. Patients with a nonoperative brain injury and an operative facial or orthopedic fracture were selected from two randomized trials previously performed at our Level I trauma center. Data were abstracted from medical records and outcome had been prospectively gathered as part of the two clinical trials.

RESULTS: Patients undergoing early or late surgery had similar demographics, overall injury severity, traumatic brain injury severity, and admission characteristics. The early group had more open orthopedic fractures, but also underwent multiple operations more often than did the late group. At 6 months postinjury, patients in the early group had a better composite neuropsychological score than did those in the late group on unadjusted analysis and after including a propensity score. After adjusting for potential confounders, this difference was significant. No significant differences in return to work or Glasgow Outcome Score were noted. The late group had a higher incidence of pneumonia and a longer hospital stay (p<0.10).

CONCLUSIONS: In traumatic brain injury patients with multisystem trauma, early timing of orthopedic and facial fracture fixation under general anesthesia was not associated with worse neuropsychological or functional outcome when compared with the outcomes associated with late surgery. Clinical conclusions may be limited by inherent selection bias and unmeasured confounding. However, these results contribute to equipoise regarding timing of surgery after multiple injuries, and emphasize the need for a randomized trial.

Author List

Wang MC, Temkin NR, Deyo RA, Jurkovich GJ, Barber J, Dikmen S

Author

Marjorie Wang MD Clinical Transformation Officer, Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Anesthesia, General
Brain Injuries
Cohort Studies
Female
Humans
Male
Multiple Trauma
Neuropsychological Tests
Orthopedic Procedures
Recovery of Function
Retrospective Studies
Time Factors
Trauma Severity Indices
Treatment Outcome