Surgical Management and Short-Term Functional Outcomes in Moderate-to-Severe Traumatic Brain Injury: A Prospective Observational Study

Background: TBI remains a leading cause of death and disability worldwide, particularly in low- and middle-income countries where delays in prehospital stabilization and limited neurosurgical resources compromise outcomes. Objectives: Evaluate demographics, surgical modalities, complications, and short-term outcomes of adults undergoing craniotomy or decompressive craniectomy for moderate to severe TBI at a tertiary care hospital. Methods: Prospective observational cohort of 60 adults (≥18 years) with admission GCS ≤12 and CT evidence of intracranial hematoma or edema requiring surgery at Aziz Fatimah Hospital, Faisalabad, Pakistan, from January to December 2024. Data on demographics, injury mechanism, surgical approach, operative metrics, complications, ICU and hospital stay, in-hospital mortality, and Glasgow Outcome Scale (GOS) at discharge were collected. All surgeries were performed under general anesthesia with asepsis. Results: Mean age 35.2 years; 70% male; road traffic accidents accounted for 60% of injuries. Craniotomy was performed in 45 cases (75%) and decompressive craniectomy in 15 (25%). Mean operative time was 120 minutes and mean blood loss was 450 mL. ICP monitoring was utilized in 46.7% of patients. Overall complication rate was 38.3%, led by surgical-site infection (16.7%) and seizures (13.3%). Mean ICU stay was 5.2 days and hospital stay was 12.4 days. In-hospital mortality was 16.7%, higher after craniectomy (26.7% vs. 13.3%). Favorable discharge (GOS 4–5) occurred in 66.7% of survivors. Admission GCS was 7.5 ± 2.3. Conclusions: Timely surgical intervention in moderate to severe TBI in this setting yields acceptable mortality and favorable short-term outcomes in two-thirds of patients. Enhancing infection control, hemorrhage management, and neurocritical care capacity may further improve prognosis.