• Acta clinica Croatica · Dec 2021

    DOES THE TYPE OF SURGERY IN BRAIN ABSCESS PATIENTS INFLUENCE THE OUTCOME? ANALYSIS BASED ON THE PROPENSITY SCORE METHOD.

    • Ana Penezić, Marija Santini, Zdravko Heinrich, Darko Chudy, Pavle Miklić, and Bruno Baršić.
    • 1Department of Otorhinolaryngology and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2Department of Neuroinfectology and Intensive Care Unit, Dr. Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia; 3Zagreb University School of Medicine, Zagreb, Croatia; 4Department of Neurosurgery, Zagreb University Hospital Center, Zagreb, Croatia; 5Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia; 6Department of Neurosurgery, Zagreb Children's Hospital, Zagreb, Croatia; 7Intensive Care Unit, Dubrava University Hospital, Zagreb, Croatia.
    • Acta Clin Croat. 2021 Dec 1; 60 (4): 559-568.

    AbstractThere 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.

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