Outcomes and Factors Associated with Outcome Following Decompressive Craniectomy for Severe Traumatic Brain Injury: A Retrospective Descriptive and Analytical Study from a Nigerian Tertiary Hospital

Abstract

Background: Decompressive craniectomy (DC) is an established surgical option for selected patients with severe traumatic brain injury (TBI) and refractory intracranial hypertension. However, evidence from resource-constrained settings remains limited. This study evaluated treatment outcomes and factors associated with clinical outcome among patients with severe traumatic brain injury who underwent decompressive craniectomy at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria. Methods: This retrospective descriptive and analytical study included all patients with severe traumatic brain injury who underwent decompressive craniectomy between January 2020 and December 2024 at EKSUTH. Demographic, clinical, radiological, operative and outcome data were retrieved from hospital records using a structured data extraction proforma. Functional outcome at 3 months after trauma was assessed using the Glasgow Outcome Score (GOS). Continuous variables were summarised using descriptive statistics, while categorical variables were analysed using the Chi-square test or Fisher's exact test, as appropriate. Owing to the relatively small sample size (n = 38), multivariable logistic regression was not performed. Statistical significance was defined as p < 0.05. Results: Thirty-eight patients were included, with a mean age of 34.8 ± 12.6 years; 81.6% were male. Road traffic accidents accounted for 76.3% of injuries, while acute subdural haematoma was the most common computed tomography finding (63.2%). Overall mortality was 34.2%, and 36.8% of patients achieved a favourable outcome (GOS 4–5). On bivariate analysis, older age (≥50 years), admission Glasgow Coma Scale score of 3–5, bilateral fixed pupils, midline shift greater than 5 mm, obliterated basal cisterns, delayed surgery and associated extracranial injuries were significantly associated with unfavourable outcome (p < 0.05). Conclusion: Decompressive craniectomy remains an important treatment option for carefully selected patients with severe traumatic brain injury in resource-limited settings. Several clinical and radiological variables were associated with unfavourable outcome; however, these findings should be interpreted cautiously because of the limited sample size. Larger prospective multicentre studies with long-term follow-up are required to validate these observations.