Time-to-surgery for traumatic brain injury in the hyperacute period: a systemic review and meta-analysis

To study the functional outcomes of traumatic brain injury (TBI) patients who have undergone surgical intervention in the hyperacute phase (<24 h). Cochrane Library, PubMed, Embase, Medline and Web of Science databases. A meta-analysis of 7 trials involving 237 patients was performed. Patients were categorized into two groups based on time to surgery: within 6 h and within 24 h. Patients were also categorized into developed and developing regions. Effect estimates were calculated using a fixed-effects model and heterogeneity was assessed with Cochrane I² statistic. Our findings revealed that those who underwent neurosurgery in the hyperacute phase of TBI were at risk of adverse outcomes. The odds ratio (OR) was 1.50 (95% CI 1.03–2.19). Subgroup analysis demonstrated that TBI patients who underwent surgery within 6 h were at a greater risk of adverse effects (OR, 1.72; 95% CI, 1.08–2.74). Moreover, a greater risk was observed in developing regions (OR, 2.33; 95% CI, 0.97–5.58). Earlier neurosurgical intervention in the acute phase of TBI might result in higher incidence of adverse events. Surgery would be postponed for TBI patients whose initial GCS score is greater than 8 during the hyperacute period.