Effects of timing to surgery on outcomes among adult patients with traumatic expansive intracranial hematomas in a sub-Saharan tertiary hospital: A prospective cohort study

Abstract

Abstract Background Despite the fact that traumatic expansive intracranial hematomas (EIH) are frequent, it is debatable whether the timing of surgery affects the prognosis of patients. The study assessed the effect of timing to surgery on outcomes among adult patients with EIH at Mulago National Referral hospital (MNRH). Methods A prospective study was conducted among adult TBI patients with intracranial hematoma during a period of 1 year and follow up for 6 months. Participants were grouped into two arms based on the early (within 24 hours) or late (over 24 hours) surgical evacuation of EIH. The Kaplan–Meier survival curve and log-rank test were used to test for differences in survival status among groups. The level of significance was determined at a p-value of < 0.05. Results The analysis covered 324 individuals in all, and 10.2% of them died. Majority of patients (59.6%) had delayed surgery. Patients who underwent early surgery within 24 hours of accident had a median time to mortality of 2 days while those who underwent surgery more than 24 hours had a median time to mortality of 4 days (p=0.004). Patients who underwent early surgery had a median LOS similar to those who had late surgery of 2 days(p=0.278). The overall survival was 46.6%, 95% CI= (17.0 to 71.9). The survival was significantly influenced by QoLIBRI, GOS, SDH, SAH, contusion. Among the survivors, 73.8% were in good functional outcome at discharge. Surgical timing groups were different according to mortality, QoLIBRI at 180 days, which was on average lower in the late surgery group, and complications, which were higher in the same group. Delayed surgery was more associated with posttraumatic seizures (PTS), infection, bleeding, pneumonia, paralysis, nausea, vomiting and decompressive craniectomy. Conclusion Early surgery was associated with early mortality, but was neither associated with shorter LOS nor with better survival. Late surgery was associated with lower long-term QoLIBRI, higher complication rate. This study demonstrates that there are still differences in outcome about when to operate. Further high-quality studies are needed to solve this disparity.