Abdominal and pelvic surgery in traumatic brain injury patients; a registry-based retrospective analysis.

Abstract

Background: Concurrent injuries with traumatic brain injury (TBI) can significantly impact patient prognosis. Abdominal and pelvic injuries accompanying TBI are infrequent and less discussed. We aimed to investigate the characteristics and outcomes of TBI patients who underwent abdominopelvic surgeries.

Methods: This cross-sectional study examined TBI patients aged 14 and older admitted to a level-I trauma center between 2016 and 2018. The independent variables were the routinely recorded information for trauma patients by physicians and nurses in the emergency department. The outcome measures were the occurrence of abdominopelvic surgeries in TBI patients, and the functional outcome assessed using the Glasgow Outcome Scale Extended (GOSE) score, classified as favorable or unfavorable outcome groups at discharge and six-month follow-up.

Results: 1279 patients were included in the analysis. Among them, the overall prevalence of concomitant abdominal or pelvic injuries, including both surgical and non-surgical cases, was approximately 15%, and 93 (7.3%) underwent abdominopelvic surgery. The presence of basilar skull fractures (OR = 1.977,95%CI = 1.106-3.534), the need for decompressive craniectomy (OR = 3.586,95%CI = 1.399-9.194), younger age (OR = 0.982,95%CI = 0.966-0.998), and lower admission blood pressures (OR = 0.973,95%CI = 0.962-0.984) were independently associated with an increased likelihood of requiring abdominopelvic surgeries. Patients who underwent abdominopelvic surgeries were less likely to have a favorable 6-month outcome (OR = 0.526,95% CI: 0.285-0.970). Among surgical subtypes, pelvic surgery was strongly associated with worse outcomes across all endpoints: unfavorable 6-month outcome (OR = 6.016,95% CI: 1.972-18.351), unfavorable discharge outcome (OR = 7.723,95%CI:1.138-52.414), 6-month mortality (OR = 9.342, 95%CI:1.502-58.087), and in-hospital mortality (OR = 12.751,95%CI: 2.183-74.491). Conversely, splenic surgery was associated with reduced odds of unfavorable discharge outcome (OR = 0.174,95% CI: 0.035-0.870).

Conclusion: Abdominopelvic surgeries in patients with TBI, particularly pelvic surgeries, are strongly associated with unfavorable functional outcomes and higher mortality. These findings highlight the prognostic importance of specific surgical interventions in polytrauma patients with TBI.