Timing of Surgery and Inflammatory Response in Traumatic Brain Injury
Author Information
Author(s): Lekuya Hervé Monka, Cose Stephen, Nakibuule Marjorie, Ahimbisibwe Gift, Fuller Anthony, Kamabu Larrey Kasereka, Biryabarema Emmanuel, Olweny Geoffrey, Kateete David Patrick, Kirabira Anthony, Makumbi Fredrick, Vandersteene Jelle, Baert Edward, Galukande Moses, Kalala Jean-Pierre Okito
Primary Institution: Makerere University, Kampala, Uganda and Ghent University, Ghent, Belgium
Hypothesis
The timing of major TBI surgery under general anesthesia in the acute phase of injury may modify the expression of perioperative inflammatory cytokines that could be clinically relevant for the surgical outcomes.
Conclusion
Delayed surgical intervention beyond 48 hours post-injury in mild–moderate TBI patients results in a significantly increased postoperative inflammatory response.
Supporting Evidence
- Serum levels of TNF-α were significantly higher after surgeries done >48 hours compared to those done ≤48 hours.
- Patients who developed later surgical site infections had significantly increased post-operative mean serum levels of IL-10.
- Neurological deficits, post-traumatic seizures, and reduced hemoglobin were associated with heightened inflammatory responses.
Takeaway
If someone gets a head injury, it's better to have surgery within two days to avoid more inflammation and complications later.
Methodology
A prospective cohort study was conducted among TBI patients with depressed skull fractures, collecting clinical-radiological data and pre-and postoperative venous samples to quantify serum levels of inflammatory cytokines.
Potential Biases
The study was conducted in a single center with a relatively small sample size, which may limit the generalizability of the results.
Limitations
The allocation of surgical timing might have been affected by the inherent decision of the neurosurgical team, and the study was conducted during a period of COVID-19 which may have influenced patient referrals.
Participant Demographics
Median age of 25.5 years, majority male (85.4%), with 48.8% victims of assaults.
Statistical Information
P-Value
0.0327
Confidence Interval
95%CI not specified
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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