Functional Outcome of Adult Traumatic Brain Injury Patients Treated by Decompressive Craniectomy: A Multi-centered Hospital Based Study.

Abstract

Abstract Background: Surgical removal of a portion of the skull, known as decompressive craniectomy (DC) is performed to relieve elevated intracranial pressure and to improve outcomes in Traumatic Brain Injury (TBI) patients. This study is the first of its kind to assess functional outcome of DC for TBI patients in Ethiopian setup to the principal investigators knowledge. Objective: This study describes the long-term functional outcome of TBI patients treated by DC and identifies factors that affect functional outcome. Method: A multi-centered, cross-sectional study design was used to collect data on decompressive craniectomy performed for patients with TBI admitted from May 1, 2018, to May 1, 2021, G.C. Structured extended Glasgow outcome scale (GOSE) questionnaire was used to collect data using in depth phone interview to assess long-term outcome in the survivors. Univariate analysis was done for descriptive statistics using frequency, mean, median, range, and standard deviation. Multivariate regression analyses were used to determine the predictors of functional outcomes. A p-value of less than 0.05 was considered statistically significant. Result: Seventy-four patients were included in this study. Mean age at time of DC was 33.9 years (range 17–69) with male to female ratio of 11.3:1. Assault was the cause of TBI in 40%. The mean GCS at admission was 8.2 (range, 3–14). Pupillary abnormality was present in 60.8% of patients. Primary DC was done in 93.2%. In Hospital mortality rate was 24.3%. The overall mortality rate was 36.5%. Forty-seven survivors (63.5%) were followed for a median period of 13 months (range, 12–18 months). Favorable functional outcome (GOSE ≥4) was seen in forty-three patients (58.1% overall, and in 91.5% of survivors). 85.7% of patients with GCS≤ 5 had unfavorable functional outcome. Complications occurred in 64.9%. Bone replacement was done for 80.9% of survivors at median duration of 5 month (range, 1 - 9). Age ≥ 40, [p= 0.045; AOR= 4.380; 95% CI= 1.031 - 18.606], GCS ≤ 5 [P= 0.006; AOR= 18.557; 95% CI= 2.290 - 150.354], presence of chest infections [P= 0.013; AOR= 5.202; 95% CI =1.417 - 19.097], and presence of noninfectious complications [p=0.035; AOR=4.009; 95%CI=1.100-14.607] were an independent predictors of unfavorable functional outcome. Conclusions: In this study, we demonstrated a good outcome with DC for TBI comparable to other studies. Age, Admission GCS, presence of postoperative chest infection, and presence of noninfectious complications were an independent predictors of unfavorable functional outcomes. Mortality rate and unfavorable outcome were significantly higher in patients with GCS ≤ 5. The effect of this finding on future decision-making need to be evaluated by a prospective multicenter study with large sample size. Keywords: Decompressive craniectomy, surgical outcome, factors affecting the surgical outcome