LAUSR

OBJECTIVE Primary decompressive craniectomy (DC) is an important therapeutic technique for severe head-injured patients with space-occupying lesions in emergency situations, but these patients are still at high risk for unfavorable outcomes. This study aimed to investigate the predictors of 30-day mortality in adult patients undergoing primary DC after traumatic brain injury (TBI). METHODS The authors included all adult patients (≥18 years of age) who underwent primary DC from January 2012 to March 2019. Demographic, clinical, surgical and laboratory variables were collected for analysis. The authors defined early mortality as 30-day mortality after DC. First, an univariate analysis (P<0.05) was used to compare survivors and nonsurvivors. Multivariate logistic regression analysis was used to identify the predictors of 30-day mortality for patients who underwent primary DC. RESULTS A total of 387 patients were enrolled in the study. The 30-day mortality rate was 31.52% (122/387). The median age at presentation was 49 years [IQR 38-60], and 316 (81.65%) patients were male. In the multivariate logistic regression analysis, the factors associated with 30-day mortality included age (OR 1.068 [95% CI 1.040-1.096]; P<0.001), bilateral unreactive pupils (OR 12.734 [95% CI 4.129-39.270]; P<0.001), subdural hemorrhage (OR 3.468 [95% CI 1.305-9.218]; P<0.013), completely effaced basal cistern (OR 3.52 [95% CI 1.568-7.901]; P=0.002), intraoperative hypotension (OR 11.532 [95% CI 4.222-31.499]; P<0.001), preoperative activated partial thromboplastin time (APTT) (OR 6.905 [95% CI 2.055-23.202]; P=0.002), and injury severity score (ISS) (OR 1.081 [95% CI 1.031-1.133]; P=0.002). CONCLUSIONS In patients undergoing primary DC after TBI, the predictors of 30-day mortality include age, bilateral unreactive pupils, subdural hemorrhage, completely effaced basal cistern, intraoperative hypotension, preoperative APTT, and ISS.