Outcomes After Traumatic Brain Injury Surgery: Investigating Racial Disparities

Introduction Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality, especially among older adults. This study investigates racial disparities in surgical outcomes among patients undergoing craniectomy for TBI, highlighting differences in perioperative variables and postoperative complications. Methods We conducted a retrospective cohort analysis using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2016 to 2021. Patients who underwent craniectomy for TBI were identified using CPT codes 61304, 61305, 61312, 61306, 61345, 61320, 61322, 61100, and 61321. Univariate analysis, including t-tests for continuous variables and Chi-square tests for categorical variables, was used to compare outcomes between racial groups, with a specific focus on white versus African American and Asian (AA/A) patients. Results A total of 2,093 patients were included (mean age 69.6 ± 15.0 years; BMI 26.8 ± 5.7). AA/A patients had longer operative times (1.7 ± 1.3 vs. 1.6 ± 0.8 hours, p = 0.03) and hospital stays (10.5 ± 8.3 vs. 9.3 ± 6.7 days, p < 0.001). Return to the operating room was higher in AA/A patients (16.2%) than white patients (11.6%, p = 0.011). Frailty was more common in AA/A patients (35.0% vs. 29.1%, p = 0.03). White patients had higher 30-day mortality (21% vs. 13.1%, p < 0.001), bleeding complications (24.2% vs. 16.6%, p < 0.001), and hyponatremia (19.3% vs. 11.0%, p < 0.001). Acute renal failure was more prevalent among AA/A patients (2.2% vs. 0.2%, p < 0.001). Rates of sepsis and surgical site infection were not significantly different. Discussion Our analysis reveals nuanced racial disparities in surgical outcomes following craniectomy for TBI, with differing risk profiles across groups. Conclusion Addressing these disparities is essential to improving perioperative care and long-term outcomes for all TBI patients, particularly among racially diverse populations.