Original scientific paper

https://doi.org/10.20471/acc.2021.60.04.01

Does the Type of Surgery in Brain Abscess Patients Influence the Outcome? Analysis Based on the Propensity Score Method

Ana Penezić ; Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Marija Santini ; Department of Neuroinfectology and Intensive Care Unit, Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; Zagreb University School of Medicine, Zagreb, Croatia
Zdravko Heinrich ; Department of Neurosurgery, Zagreb University Hospital Center, Zagreb, Croatia
Darko Chudy ; Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
Pavle Miklić ; Department of Neurosurgery, Zagreb Children’s Hospital, Zagreb, Croatia
Bruno Baršić ; Zagreb University School of Medicine, Zagreb, Croatia; Intensive Care Unit, Dubrava University Hospital, Zagreb, Croatia

Abstract

There are different options for surgical treatment of brain abscess, mainly standard
craniotomy and stereotactic aspiration. It has not yet been established which of these options is associated
with a more favorable outcome under similar baseline conditions of patients. Demographic characteristics,
microbiology, clinical presentation, and treatment outcome were analyzed for surgically
treated adult patients with brain abscess over a 14-year period. A propensity score model was applied
to account for baseline conditions that may determine the choice of neurosurgical method. The propensity
score was included in the prediction of a favorable outcome, defined as a Glasgow Outcome
Scale (GOS) score 4 or 5. We analyzed 91 adult surgically treated patients, of which 53 had standard
craniotomy and 38 stereotactic aspiration of brain abscess. Focal neurological deficit was the most
common symptom present in 60 (65.9%) patients on admission. Sixty-seven (73.6%) patients had
GOS 4 or 5, and seven (7.7%) patients died. The choice of surgery did not influence the outcome (OR
1.181, 95% CI 0.349-3.995), neither did the time elapsed from diagnosis to surgery (OR 0.998, 95%
CI 0.981-1.015). Propensity towards standard craniotomy procedure did not influence outcome in
brain abscess patients (OR 1.181, 95% CI 0.349-3.995). Worse outcome (GOS below 4) was independently
associated with Glasgow Coma Score (GCS) on admission (OR 0.787, CI 0.656-0.944).
The choice of neurosurgical procedure did not influence the outcome in patients with brain abscess.
Patients with brain abscess who had lower GCS on admission also had worse outcome.

Keywords

Brain abscess; Craniotomy; Stereotactic aspiration; Glasgow Outcome Scale

Hrčak ID:

275424

URI

https://hrcak.srce.hr/275424

Publication date:

1.12.2021.

Article data in other languages: croatian

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