Risk Factors for Heterotopic Ossification in Traumatic Brain Injury: An Analysis of the Korean National Health Insurance Service Data

Abstract

Purpose: This study investigated the risk factors for heterotopic ossification (HO) in patients with traumatic brain injury (TBI). Materials and Methods: This was a retrospective study using the Korean National Health Insurance Service (KNHIS) database and included as many relevant factors as possible. Data were collected from the KNHIS cohort, a nationwide cohort covering the entire Korean population. Patients diagnosed with TBI from 2004 to 2018 were included. TBI was defined as individuals who 1) had been hospitalized, 2) were diagnosed with TBI under ICD-10 code S06, and 3) underwent brain imaging within 1 week before or after diagnosis. Among 637315 adult patients, 1909 (0.30%) developed HO. This study aimed to clarify the relationship between HO and various factors, including demographic and medical history, medication history, complications, and accompanying injuries in TBI patients. Results: Among TBI patients, HO was more common in female and peaked in patients in their 50s, with a lower incidence in their 70s. Preobesity and obesity were significant risk factors, while smokers had a reduced risk. HO was more common in patients with rheumatic diseases and medical comorbidities, and those who had undergone tracheostomies. The use of antiseptics was associated with an increased risk, whereas anticonvulsants, antithrombotics, steroids, and non-steroidal anti-inflammatory drugs were associated with lower risks. HO was more common in registered patients with disability due to brain lesion. Conclusion: In conclusion, middle-age range, female sex, obesity, comorbidities, injury severity, systemic inflammation, and bony metabolism-affecting medications appear to increase the risk of HO in patients with TBI.