Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

Objective: To assess the association between immediate postoperative coagulopathy and the long-term survival of traumatic brain injury (TBI) patients undergoing surgery, as well as to explore predisposing risk factors of immediate postoperative coagulopathy.Methods: This retrospective study included 352 TBI patients from January 1, 2015, to April 25, 2019. The log-rank test and a Cox proportional hazard model were conducted to assess the relationship between immediate postoperative coagulopathy and the long-term survival of TBI patients. Furthermore, a multivariate logistic regression model was performed to identify the underlying risk factors for postoperative coagulopathy.Results: Of the 352 patients analyzed, the median age was 50 (41,60) years, and 82 (23%) patients were female. By May 26, 2019, 117 (33.24%) patients had died, 195 (55.40%) had survived, and 40 (11.36%) had been lost to follow-up. The median follow-up time was 773 days. In the log-rank test, immediate postoperative coagulopathy was significantly associated with the survival of TBI patients (P = 0.002). A Cox proportional hazard model identified immediate postoperative coagulopathy (HR, 1.471; 95% CI, 1.011-2.141; P = 0.044) as an independent risk factor for survival following TBI. According to multivariate logistic regression analysis, abnormal ALT and RBC at admission, intraoperative infusion of crystalloid solution > 2900 mL, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL were identified as independent risk factors for immediate postoperative coagulopathy.Conclusions: Those who suffered from immediate postoperative coagulopathy due to TBI were at higher risk of poor prognosis than those who did not.