{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:09:21Z","timestamp":1790791761690,"version":"4.1.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Geriatric patients have the highest rates of Traumatic Brain Injury (TBI)-related hospitalization and death. This contributes to an assumption of futility in aggressive management in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate the effect of surgical intervention on the morbidity and mortality of geriatric patients with TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective analysis of patients \u226580 yr old with TBI from 2003 to 2016 was performed using the National Trauma Data Bank. Univariate and multivariate analyses were performed to compare outcomes between surgery and nonsurgery groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A total of 127\u00a0129 patient incidents were included: 121\u00a0185 (95.3%) without surgery and 5944 (4.7%) with surgery. The surgical group was slightly younger (84.0\u00a0vs 84.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and predominantly male (60.2%\u00a0vs 44.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Mean emergency department (ED) Glasgow Coma Scale (GCS) was lower in surgical patients (12.4\u00a0vs 13.7,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Complications (OR\u00a0=\u00a01.91, CI:1.80-2.02,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and hospital length of stay (LOS, \u00df = 5.25, CI:5.08-5.42,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) were independently associated with surgery. Intensive care unit (ICU) LOS (\u00df = 3.19, CI:3.05-3.34,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), ventilator days (\u00df = 1.57, CI:1.22-1.92,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001), and reduced discharge home (OR\u00a0=\u00a00.434, CI:0.400-0.470,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) were also independently associated with surgery. However, surgery was not independently associated with mortality on multivariate analysis (OR\u00a0=\u00a01.03, CI:0.955-1.12,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.423). Recursive partitioning analysis identified ED GCS and injury severity score (ISS) as prognosticators of mortality following surgical intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Surgical treatment of geriatric patients with TBI is associated with increased complications, hospital LOS, ICU LOS, and ventilator days as well as reduced discharge to home. However, surgery is not associated with increased mortality. ISS and ED GCS are prognosticators of mortality following surgical intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyab359","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T07:41:57Z","timestamp":1631086917000},"page":"1062-1070","source":"Crossref","is-referenced-by-count":14,"title":["The Morbidity and Mortality of Surgery for Traumatic Brain Injury in Geriatric Patients: A Study of Over 100\u00a0000 Patient Cases"],"prefix":"10.1227","volume":"89","author":[{"given":"Alexander F","family":"Haddad","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony M","family":"DiGiorgio","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young M","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony T","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F","family":"Burke","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay S","family":"Dhall","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phiroz E","family":"Tarapore","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12]]},"reference":[{"issue":"Suppl 1","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"A268","DOI":"10.1136\/ip.2010.029215.951","article-title":"Traumatic 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