{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:13:07Z","timestamp":1791213187097,"version":"4.1.0"},"reference-count":92,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Exposure to extracranial (EC) surgery early after traumatic brain injury (TBI) is associated with cognitive risks.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine whether exposure to EC surgery during a TBI index admission is associated with worse outcomes at 1 year compared with no EC surgery.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This was a retrospective secondary nested cohort study of the prospective, observational Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort study that enrolled participants from February 1, 2014, through August 31, 2018, at 18 US level I trauma centers. Participants aged 17 years or older who were admitted to an inpatient unit from the emergency department (ED) within 24 hours of trauma, had a known Glasgow Coma Scale (GCS) score and head computed tomography (CT) imaging, and did not undergo intracranial surgery were followed for up to 1 year after TBI and were analyzed for this study from July 25, 2023, to July 2, 2025.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Participants that underwent EC surgery during the index admission were compared with nonsurgical participants within the following injury subgroups: orthopedic trauma controls (OTCs), moderate-severe TBI (GCS 3-12), and computed tomography (CT) scan results that were positive (CT+) or negative (CT\u2212) for acute intracranial findings along with a GCS score of 13 to 15.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Brain injury\u2013specific functional outcomes (Glasgow Outcome Scale\u2013Extended [GOSE-TBI]), cognition (Trail Making Test [Trails] parts A and B), Disability Rating Scale (DRS), and Quality of Life After Brain Injury\u2013Overall Scale (QOLIBRI-OS). A fixed-effects linear regression model with propensity weighting for missing outcome and group imbalance in baseline characteristics was used.<\/jats:p><\/jats:sec>Results<\/jats:title>Of the 1835 participants, 1279 (70%) were male, with mean (SD) age of 42.2 (17.8) years; 1349 participants (74%) were nonsurgical and 486 (26%) underwent EC surgery. In the 1150 participants (63%) followed up at 1 year, after propensity weighting, patients undergoing EC surgery in both the CT+ TBI and moderate-severe TBI subgroups had significantly worse GOSE-TBI (B<\/jats:italic>, \u22120.57 [95% CI, \u22120.92 to \u22120.22] and \u22121.25 [95% CI, \u22121.65 to \u22120.85], respectively), Trails part B (B<\/jats:italic>, 22.7 [95% CI, 7.4-38.1] and 47.9 [95% CI, 27.0-68.8]), and DRS (B<\/jats:italic>, 2.47 [95% CI, 1.30-3.64] and 3.53 [95% CI, 2.19-4.87]) scores compared with nonsurgical participants. QOLIBRI-OS was worse after EC surgery vs no EC surgery in the subgroup with moderate-severe TBI (B<\/jats:italic>, \u221215.1 [95% CI, \u221224.3 to \u22125.9]). There was no association of EC surgery with outcomes in the OTC or CT\u2212 TBI subgroups. For example, GOSE-TBI was not associated with EC surgery in the CT\u2212 TBI subgroup (B<\/jats:italic>, 0.02 [95% CI, \u22120.24 to 0.27]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, early EC surgery was associated with adverse function, cognition, and disability after TBI rated as moderate-severe or with radiographic abnormalities on CT scan regardless of GCS at index admission but not after orthopedic trauma or CT\u2212 TBI. 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