Association Between Admission-to-Surgery Time and Outcomes in Traumatic Brain Injury at RSSA
DOI:
https://doi.org/10.22219/sm.Vol22.SMUMM1.44390Abstract
Despite evidence that streamlined trauma protocols reduce preoperative delays and improve survival, delays from emergency department admission to surgical intervention remain common and are associated with poorer outcomes. Although international guidelines recommend decompression within a four-hour “golden period,” data on adherence in Indonesia remain limited. This retrospective cohort study evaluated 91 patients with traumatic brain injury (TBI) who underwent neurosurgical intervention at Saiful Anwar Hospital, Malang, between 2023 and 2024. The association between preoperative time intervals and clinical outcomes, including mortality, Glasgow Outcome Scale at hospital discharge (GOS-HD), and length of stay (LOS), was analyzed. Admission-to-surgery time was not significantly associated with mortality (p = 0.725) or GOS-HD (p = 0.648). However, prolonged total time to surgery (p = 0.029) and extended CT-to-surgery intervals (p = 0.026) were significantly associated with increased LOS. These findings indicate that while surgical delays may not directly affect short-term survival or functional outcomes, they contribute to longer hospitalization and reduced care efficiency. Efforts to minimize post-CT delays may improve workflow and optimize trauma care delivery.
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References
American College of Surgeons. 2024. Best Practices Guidelines The Management of Traumatic Brain Injury.
Chandra, J. and Tobing, W.L. 2021. Risk factors of mortality due to traumatic brain injury in Marsidi Judono general hospital, Belitung, Indonesia. Indonesian Journal of Neurosurgery 4(3). doi: 10.15562/ijn.v4i3.163.
Chockalingam, K., Rahman, N.A.A., Idris, Z., Theophilus, S.C., Abdullah, J.M., Ghani, A.R.I. and Ali, A. 2023. Door-to-Skin Time in Patient Undergoing Emergency Trauma Craniotomy. Malaysian Journal of Medical Sciences 30(4), pp. 71–84. doi: 10.21315/mjms2023.30.4.7.
Demlie, T.A., Alemu, M.T., Messelu, M.A., Wagnew, F. and Mekonen, E.G. 2023. Incidence and predictors of mortality among traumatic brain injury patients admitted to Amhara region Comprehensive Specialized Hospitals, northwest Ethiopia, 2022. BMC Emergency Medicine 23(1). doi: 10.1186/s12873-023-00823-9.
Egas Terán, M.I. and González-Andrade, F. 2025. Time-to-treatment in traumatic brain injury: unraveling the impact of early surgical intervention on patient outcomes. Neurological Research, pp. 1–10. doi: 10.1080/01616412.2025.2515523.
Feng, T., Zhao, P., Wang, J., Du, X., Ai, M., Yang, J. and Li, J. 2025. Improving Patient Outcomes in mTBI: The Role of Integrated Nursing Interventions in the Emergency Department. Therapeutics and clinical risk management 21, pp. 69–80. doi: 10.2147/TCRM.S500328.
Hirani, R., Podder, D., Stala, O., Mohebpour, R., Tiwari, R.K. and Etienne, M. 2025. Strategies to Reduce Hospital Length of Stay: Evidence and Challenges. Medicina 61(5), p. 922. doi: 10.3390/medicina61050922.
Khawprapa, C. and Khawprapa, S. 2025. The Impact of Time from Diagnosis to Operating Room on Functional Outcomes in Patients with Traumatic Brain Injury: A Retrospective Study. Mary Ann Liebert, Inc Publisher 6.1. Available at: http://online.liebertpub.com/doi/10.1177/08977151251366985.
Maas, A.I.R. et al. 2022. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. The Lancet Neurology 21(11), pp. 1004–1060. doi: 10.1016/S1474-4422(22)00309-X.
MAGALHÃES, A.L.G. et al. 2022. Traumatic brain injury in Brazil: an epidemiological study and systematic review of the literature. Arquivos de Neuro-Psiquiatria 80(4), pp. 410–423. doi: 10.1590/0004-282x-anp-2021-0035.
Mehmood, A., Rowther, A.A., Kobusingye, O., Ssenyonjo, H., Zia, N. and Hyder, A.A. 2021. Delays in emergency department intervention for patients with traumatic brain injury in Uganda. Trauma surgery & acute care open 6(1), p. e000674. doi: 10.1136/tsaco-2021-000674.
Menteri Kesehatan Republik Indonesia. 2022. Pedoman Nasional Pelayanan Kedokteran Tatalaksana Cedera Otak Traumatik. Indonesia : https://yankes.kemkes.go.id/unduhan/fileunduhan_1681539971_246974.pdf. pp. 9–51.
Merakis, M., Lewis, D.P., Weaver, N. and Balogh, Z.J. 2024. Time from injury to operative intervention in traumatic intracranial hematoma: A systematic literature review and meta‐analysis. World Journal of Surgery 48(9), pp. 2273–2282. doi: 10.1002/wjs.12298.
National Academies of Sciences, E. and M.H. and M.D.B. on H.C.S.B. on H.S.P.C. on A.P. in T.B.I.R. and C. 2022. Traumatic Brain Injury. Berwick, D., Bowman, K., and Matney, C. eds. Washington, D.C.: National Academies Press. Available at: https://www.ncbi.nlm.nih.gov/books/NBK580081/pdf/Bookshelf_NBK580081.pdf [Accessed: 16 April 2026].
Niazie, A., Khany Jasa, Z. and Rahmi, Y. 2026. Predictors of Neurosurgical Outcomes in Traumatic Brain Injury: A Study from Banda Aceh, Indonesia. Jurnal Neuroanestesi Indonesia 15, pp. 8–16. Available at: https://doi.org/10.24244/jni.v15i1.750.
NICE. 2024. Head injury: assessment and early management.
Niemeyer, M.J.S., Jochems, D., Houwert, R.M., van Es, M.A., Leenen, L.P.H. and van Wessem, K.J.P. 2022. Mortality in polytrauma patients with moderate to severe TBI on par with isolated TBI patients: TBI as last frontier in polytrauma patients. Injury 53(4), pp. 1443–1448. doi: 10.1016/j.injury.2022.01.009.
Papa, L. and Goldberg, S.A. 2018. Head Trauma. In: Walls, R. M. ed. ROSEN’S EMERGENCY MEDICINE Concepts and Clinical Practice. ninth edition. Philadelphia: Elsevier, Inc, pp. 301–328.
Quispe-Alcocer, J., Biroli, A. and González-Andrade, F. 2025. Impact of Delayed Trauma Unit Admission on Mortality and Disability in Traumatic Brain Injury Patients. International Journal of Environmental Research and Public Health 22(10). doi: 10.3390/ijerph22101566.
Rahman, F.N., Das, S., Kader, M. and Mashreky, S.R. 2025. Epidemiology, outcomes, and risk factors of traumatic brain injury in Bangladesh: a prospective cohort study with a focus on road traffic injury-related vulnerability. Frontiers in Public Health 13. doi: 10.3389/fpubh.2025.1514011.
Shakir, M. et al. 2023. Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review. World Neurosurgery 180, pp. 169-193.e3. doi: 10.1016/j.wneu.2023.09.007.
Shakir, M. et al. 2024. Temporal Delays in the Management of Traumatic Brain Injury: A Comparative Meta-Analysis of Global Literature. World Neurosurgery 188, pp. 185-198.e10. doi: 10.1016/j.wneu.2024.05.064.
Sudadi, S., Nugroho, F.A. and Deviatika, F.E. 2025. The Association Between Surgical Waiting Time and Glasgow Outcome Scale–Extended (GOSE) in Traumatic Brain Injury Patients Undergoing Craniotomy at Dr. Sardjito General Hospital. F1000Research 2025, pp. 1–11.
Tsai, C.-H. et al. 2024. Association between Time to Emergent Surgery and Outcomes in Trauma Patients: A 10-Year Multicenter Study. Medicina 60(6), p. 960. doi: 10.3390/medicina60060960.
Vika, T.S.K., Ani Asriani Basri, Fariz Zuvil Arganata and Nafilatul Fitri. 2024. Knowledge and Attitudes regarding Compliance with the Use of Personal Protective Equipment for Motor Vehicle Test Workers at the Malang Regency Transportation Service. Saintika Medika 20(1), pp. 54–64. doi: 10.22219/sm.Vol20.SMUMM1.32691.
Xue, P. et al. 2026. The green channel surgical mode for traumatic brain injury can reduce the mortality rate of patients with severe traumatic brain injury- a single center analysis from China. Neurosurgical Review 49(1), p. 200. doi: 10.1007/s10143-026-04153-9.
Zarmer, L., Khan, M.S., Islat, G., Alameddin, H., Massey, M., Kazui, S. and Chaudhry, R. 2025. Traumatic Brain Injury: Advances in Diagnostic Techniques and Treatment Modalities. Journal of Clinical Medicine 14(20), p. 7145. doi: 10.3390/jcm14207145.
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