title: Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan.
abstract: OBJECTIVE
  The authors sought to analyze trends in hospital resource utilization and mortality rates in a population of patients who had received traumatic brain injury (TBI) surgery.
  
  
  METHODS
  This nationwide population-based cohort study retrospectively analyzed 18,286 patients who had received surgical treatment for TBI between 1998 and 2010. The multiple linear regression model and Cox proportional hazards model were used for multivariate assessment of outcome predictors.
  
  
  RESULTS
  The prevalence rate of surgical treatment for patients with TBI gradually but significantly (p < 0.001) increased by 47.6% from 5.0 per 100,000 persons in 1998 to 7.4 per 100,000 persons in 2010. Age, sex, Deyo-Charlson comorbidity index score, hospital volume, and surgeon volume were significantly associated with TBI surgery outcomes (p < 0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 19.06%, whereas the in-hospital mortality rate decreased 10.9%. The estimated mean time of overall survival after TBI surgery (± SD) was 83.0 ± 4.2 months, and the overall in-hospital and 1-, 3-, and 5-year survival rates were 74.5%, 67.3%, 61.1%, and 57.8%, respectively.
  
  
  CONCLUSIONS
  These data reveal an increased prevalence of TBI, especially in older patients, and an increased hospital treatment cost but a decreased in-hospital mortality rate. Health care providers and patients should recognize that attributes of the patient and of the hospital may affect hospital resource utilization and the mortality rate. These results are relevant not only to other countries with similar population sizes but also to countries with larger populations.
authors.affiliation: Department of Healthcare Administration and Medical Informatics and.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.forename: Shiuh-Lin
authors.initials: SL
authors.lastname: Hwang
authors.forename: I-Chen
authors.initials: IC
authors.lastname: Lee
authors.forename: I-Te
authors.initials: IT
authors.lastname: Chen
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.forename: Chih-Lung
authors.initials: CL
authors.lastname: Lin
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017048:Health Care Costs / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D006767:Hospitals, District / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data; D013624:Taiwan / Q000453:epidemiology
keywords: BNHI = Bureau of National Health Insurance; DCCI = Deyo-Charlson comorbidity index; ICD-9-CM = International Classification of Diseases Ninth Revision Clinical Modification; IQR = interquartile range; LOS = length of stay; TBI = traumatic brain injury; hospital resource utilization; mortality rate; predictors; traumatic brain injury; trends