Risk factors for heterotopic ossification in traumatic brain injury: An analysis of the Korean National Health Insurance Service Data

Abstract

Abstract We investigated the risk factors for heterotopic ossification (HO) in patients with traumatic brain injury (TBI) using a large nationwide cohort, the Korean National Health Insurance Service (KNHIS) data from 2002 to 2018. We included as many factors that could be defined using the KNHIS data as possible. A multivariable logistic regression model was used. Among 637,315 patients with TBI, HO occurred in 1,909 (0.30%) and more often in women than in men. The incidence increased in patients in their 50s and decreased in those in their 70s. Preobesity and obesity were also significant risk factors for HO, although HO was less common in current smokers. HO was more common in patients with rheumatic diseases and medical comorbidities and those who had undergone tracheostomies. Antiseptics were 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. 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.