Risk Factors Associated With Mortality in Patients With Otogenic Brain Abscess

Objective: Otogenic brain abscess is a well-recognized clinical condition that describes brain abscess secondary to an ear infection or mastoiditis. Current evidence remains limited on risk factors associated with mortality as most data are from case series. We aimed to 1) report the mortality rate among patients who did and did not receive mastoidectomy 2) identify factors associated with inpatient mortality. Study Design: Retrospective cohort study. Setting: Multi-institutional. Patients: We identified a cohort of patients for years 2008 to 2014 who in their inpatient hospitalization carried the diagnoses of both brain abscess and infectious ear disease. Interventions: Inpatient neurotology and neurosurgical procedures. Main Outcome Measures: A multivariable logistics regression model was built to identify the factors associated with inpatient mortality. Results: The final analysis included 252 patients, of which 84 (33.3%) underwent mastoidectomy. The rate of inpatient morbidity and mortality were 17.5% and 4.0%, respectively. The rate of mortality in patients without mastoidectomy versus those with mastoidectomy was 4.2% versus 3.6%, respectively (p > 0.99). The odds of inpatient mortality were significantly increased for every 10-year increase in age (odds ratio [OR] 2.73, 95% confidence interval [CI]: 1.39–7.01, p = 0.011) and for Black compared to White patients (OR: 45.81, 95% CI: 4.56–890.92, p = 0.003). Conclusion: Older age and Black race were associated with increased odds of inpatient mortality and there were no significant differences in mortality between mastoidectomy cohorts. This research serves to generate further hypotheses for larger observational studies to investigate the association between sociodemographic factors and surgical variables with outcomes among this surgical population. Address correspondence and reprint requests to Jeffrey P. Harris, M.D., Ph.D., F.A.C.S., Otolaryngology/Head and Neck Surgery, University of California San Diego, San Diego, CA; E-mail: jpharris@ucsd.edu Author contributions: B.N.B. helped with literature search, data collection, study design, analysis of data, manuscript preparation, and review of manuscript. J.S. helped with literature search, manuscript preparation, and review of manuscript. R.A.G. helped with literature search, data collection, study design, analysis of data, manuscript preparation, and review of manuscript. J.H. helped with literature search, study design, manuscript preparation, and review of manuscript. Disclaimers: None. The authors disclose no conflicts of interest. Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company

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