Outcomes After Traumatic Brain Injury Surgery: Investigating Racial Disparities

Objective: 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 ICD-10 and CPT codes (e.g., ICD-10: S06.xx, CPT: 61304, 61305, 61312, 61345, 61320, 61322, and 61321). Univariate and multivariate analysis was used to compare outcomes between racial groups, with a specific comparisons across White, Black/African American, and Asian patients. Results: A total of 2,519 patients met inclusion criteria (65.2% White, 12.2% Black, 5.8% Asian, 16.9% other). Baseline characteristics differed significantly across groups, with minority patients demonstrating greater comorbidity burden and frailty. Unadjusted 30-day mortality was highest among White patients (21.7%) compared with Black (14.7%), Asian (15.2%), and other patients (10.6%) (p < 0.001). Overall morbidity rates were similar across groups (~ 40%). Asian patients had the highest rate of return to the operating room (23.4%). After multivariable adjustment, several crude differences attenuated, while select disparities persisted, indicating that both baseline health status and perioperative factors contribute to outcome variation. Conclusion: Our analysis reveals nuanced racial disparities in surgical outcomes following craniectomy for TBI, with differing risk profiles across groups. Addressing these disparities is essential to improving perioperative care and long-term outcomes for all TBI patients, particularly among racially diverse populations.