Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Although sinusitis-induced intracranial complications rarely occur in the current era of antibiotics, they can induce neurological symptoms or death. The authors of this study investigated the association between endoscopic sinus surgery (ESS) and outcomes in patients who had undergone neurosurgical procedures for sinusitis-induced intracranial abscess.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors obtained data on patients with sinusitis-induced intracranial abscess from the Japanese Diagnosis Procedure Combination inpatient data for the period from 2010 to 2017. They excluded patients with fungal sinusitis, orbital complications, immunodeficiency, and malignant disease. They also excluded patients who had received antifungal agents, chemotherapy, immunosuppressants, and antidiabetic drugs. Eligible patients were divided into those with and those without neurosurgical procedures. Propensity score–adjusted regression analyses were performed to examine the association between ESS within the same hospitalization and outcomes (mortality, blood transfusion, readmission, revision neurosurgery, and length of stay).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of the 552 potentially eligible patients, 255 were treated with neurosurgical procedures, including 104 who underwent ESS within the same hospitalization and 151 who did not. ESS was not significantly associated with mortality (OR 0.54, 95% CI 0.05–5.81, p = 0.61), blood transfusion (OR 1.95, 95% CI 0.84–4.51, p = 0.12), readmission (OR 0.86, 95% CI 0.34–2.16, p = 0.75), revision neurosurgery (OR 0.65, 95% CI 0.24–1.74, p = 0.39), or length of stay (percent difference −10.8%, 95% CI −24.4% to 5.1%, p = 0.18).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The present study suggests that ESS may not have significant benefits with respect to reducing mortality, blood transfusion, readmission, revision neurosurgery, or length of stay.</jats:p></jats:sec>

Editorial. Endoscopic sinus surgery in sinusitis-induced intracranial abscess: concepts and controversies

“…The authors concluded that ESS does not add substantially to a reduction in mortality, readmission rates, reoperation rates, or length of hospital stay in patients with SIIA requiring neurosurgical intervention. 4 These conclusions are in contrast to some previously published reports 2,5 and are supported by others. 1,3 Koizumi et al 4 investigated the association between outcomes in patients undergoing neurosurgical interventions for SIIA and an ESS performed within the same hospitalization.…”

“…4 These conclusions are in contrast to some previously published reports 2,5 and are supported by others. 1,3 Koizumi et al 4 investigated the association between outcomes in patients undergoing neurosurgical interventions for SIIA and an ESS performed within the same hospitalization. The study design was retrospective in nature, and data on the patients with SIIA were collected from a large administrative nationwide inpatient database over a period of 8 years.…”

“…n this issue, Koizumi et al 4 have explored the largely unchartered territory of the role of endoscopic sinus surgery (ESS) in patients with sinusitis-induced intracranial abscess (SIIA) in clinical practice. Their study is a retrospective analysis of a Japanese nationwide administrative database.…”

“…Conclusions drawn from the study by Koizumi et al 4 benefit from the large sample size, use of propensity score-matched controls, multicentric nature of study population, and robust results. Additionally, the strengths of research based on large administrative databases include generalizability owing to diverse clinical settings, diverse patients, and diverse providers.…”

“…Conceptually, it is of paramount importance to under-stand whether ESS alters the natural history and progression of SIIA from sinusitis, whether concurrent drainage of the PNS and intracranial abscess is the optimal strategy to manage patients with SIIA, and whether the decisionmaking process depends on the anatomical location of the intracranial abscess in relation to sinus disease. In view of the controversial ideologies reported in the current literature, [1][2][3][4][5] the logical conclusion is to individualize the treatment plan based on the relative pros and cons of concurrent ESS and neurosurgical intervention in each instance. Until there is level I evidence from large prospective randomized controlled trials (RCTs), we may have to rely on retrospective analyses of such nationwide adminstrative databases to guide the decision-making process in clinical practice.…”