1259 Predictors of Seizures in Patients Post Op From Surgical Intervention for Traumatic Brain Injury

INTRODUCTION: Seizures are common postoperative complications for patients who have undergone surgical management for traumatic brain injury (TBI). However, little is known regarding preoperative factors that predict postoperative seizures. METHODS: A retrospective study of all operative TBI patients between 2007 and 2021 was performed. Postoperative seizures were confirmed according to documentation in the medical record. Individuals with documented seizures pre-TBI were excluded. Univariate comparisons determined factors associated with seizures, and a multivariate logistic regression was performed to determine which remained significant. RESULTS: 271 individuals were included in this study. Forty-six individuals (17%) experienced at least one documented postoperative seizure. Of those, 98% were on Levetiracetam prophylactic coverage, and 72% of individuals continued the medication for = 7 days. Factors associated with postoperative seizures included age = 60 years (p=.04), smoking history (p=.01), hypertension (p=.04), and diabetes (p=.03). A trend towards significance was seen in individuals whose injuries included subdural hematomas (p=.054). There were no differences according to initial GCS at presentation (p=.5), presence of EDH (p=.4), IPH (p=.8), SAH/IVH (p=.9), midline shift (p=.2), herniation on imaging (p=.4), Rotterdam score (p=.33), procedure (p=.4) (craniotomy or craniectomy). Those who experienced seizure had significantly longer lengths of stay (14 vs. 10.5 days; p=.03) but ultimately did not differ significantly in the following metrics to measure outcomes – mRS at discharge (p=.5), GOSE at discharge (p=.8), GOSE at last follow-up (p=.8). SDH presence (OR 4.67 CI95% 1.46 – 14.9) and former smokers (OR 3.91 CI95% 1.51 – 10.1) remained significant after multivariate analysis controlling for age, diabetes and current smoking history. CONCLUSIONS: In postoperative TBI patients, former smokers and the presence of SDH all significantly increase the risk of experiencing seizures even while on prophalactic AEDs. These factors should be considered when managing postoperative TBI patients.