Age-related mortality risk assessment and prognostic factors in postsurgical traumatic brain injury patients: A retrospective cohort study based on the mimic database

Background Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality worldwide, with surgical intervention being critical for severe cases requiring debridement. Understanding post-surgical mortality risk factors is essential for optimizing patient outcomes and clinical decision-making. To identify demographic, clinical, and laboratory prognostic factors associated with in-hospital mortality in TBI patients following craniotomy for hematoma evacuation (CHE) and develop a predictive model for mortality risk assessment. Methods This retrospective cohort study analyzed 196 TBI patients from the Medical Information Mart for Intensive Care (MIMIC) database (2001-2012) who underwent cranial debridement surgery. Baseline demographics, vital signs, and laboratory parameters were collected. The primary outcome was in-hospital mortality. Age stratification analysis categorized patients into four groups (18-30, 31-50, 51-70, and >71 years). Receiver operating characteristic (ROC) curves and restricted cubic spline analysis were employed to evaluate predictive performance and explore non-linear relationships. Results : The overall in-hospital mortality rate was 3.1% (6/196 patients). Deceased patients were significantly older than survivors (69.17±20.72 vs 50.98±17.05 years, p=0.011). Patients aged ≥71 years demonstrated a mortality rate of 50.0%, while no deaths occurred in the 18-30 age group. Laboratory findings revealed elevated white blood cell counts (13.32±5.74 vs 9.03±3.78 × 10³/μL, p=0.008) and glucose levels (162.76±56.86 vs 121.71±34.25 mg/dL, p=0.005) in the deceased group. The mortality prediction model achieved an area under the curve (AUC) of 0.796. Restricted cubic spline analysis demonstrated a significant non-linear relationship between age and mortality risk (p<0.001). Conclusions Advanced age emerged as the most critical prognostic factor for post-surgical TBI mortality, with patients over 71 years at particularly high risk. Elevated inflammatory markers and hyperglycemia were associated with increased mortality.