Outcomes After Traumatic Brain Injury Surgery: Investigating Racial Disparities in Recovery and Survival

Introduction: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality, particularly among older adults. This study examines the outcomes after TBI surgery among different racial groups and highlights disparities.

Methods: We used the ACS-NSQIP dataset to identify patients who underwent craniectomy for Traumatic Brain Injury from 2016 to 2021. We selected cases using specific CPT codes: 61304, 61305, 61312, 61306, 61345, 61320, 61322, 61100, and 61321. T-tests were used to compare continuous variables and Chi-Squared tests for categorical variables. Univariate analysis assessed the association between racial groups and surgical outcomes.

Results: A total of 2,093 patients were included, with a mean age of 69.58 years (SD = 15.02) and a body mass index (BMI) of 26.83 (SD = 5.66). African American and Asian patients had a longer mean operative time of 1.66 hours (SD = 1.28) compared to 1.56 hours (SD = 0.75) for white patients (p = 0.034). Their total length of stay was also longer, averaging 10.54 days (SD = 8.30) versus 9.26 days (SD = 6.71) for whites (p < 0.001). The return to the operating room was significantly higher in the African American and Asian group (16.2%) than in whites (11.6%), with a Pearson Chi-Square value of 6.543 (p = 0.011). The analysis of frailty using the Modified Frailty Index revealed that 35.0% of African American and Asian patients exhibited moderate or high frailty compared to 29.1% of white patients (p = 0.026). Additionally, 30-day mortality rates were significantly higher among white patients (21%) compared to African American and Asian patients (13.1%, p < 0.001).

Conclusion : This study underlines significant racial disparities in TBI surgery outcomes. The findings indicate a need for targeted interventions to address these disparities, ultimately enhancing recovery and survival outcomes for all TBI patients.