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Association of baseline frailty status and age with postoperative morbidity and mortality following intracranial meningioma resection

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Abstract

Purpose

Although numerous studies have established advanced patient age as a risk factor for poor outcomes following intracranial meningioma resection, large-scale evaluation of frailty for preoperative risk assessment has yet to be examined.

Methods

Weighted discharge data from the National Inpatient Sample were queried for adult patients undergoing benign intracranial meningioma resection from 2015 to 2018. Complex samples multivariable logistic regression models and receiver operating characteristic curve analysis were performed to evaluate adjusted associations and discrimination of frailty, quantified using the 11-factor modified frailty index (mFI), for clinical endpoints.

Results

Among 20,250 patients identified (mean age 60.6 years), 35.4% (n = 7170) were robust (mFI = 0), 34.5% (n = 6985) pre-frail (mFI = 1), 20.1% (n = 4075) frail (mFI = 2), and 10.0% (n = 2020) severely frail (mFI ≥ 3). On univariable analysis, these sub-cohorts stratified by increasing frailty were significantly associated with the development of Clavien–Dindo grade IV (life-threatening) complications (inclusive of those resulting in mortality) (1.3% vs. 3.1% vs. 6.5% vs. 9.4%, p < 0.001) and extended length of stay (eLOS) (15.4% vs. 22.5% vs. 29.3% vs. 37.4%, p < 0.001). Following multivariable analysis, increasing frailty (aOR 1.40, 95% CI 1.17, 1.68, p < 0.001) and age (aOR 1.20, 95% CI 1.05, 1.38, p = 0.009) were both independently associated with development of life-threatening complications or mortality, whereas increasing frailty (aOR 1.20, 95% CI 1.10, 1.32, p < 0.001), but not age, was associated with eLOS. Frailty (by mFI-11) achieved superior discrimination in comparison to age for both endpoints (AUC 0.69 and 0.61, respectively).

Conclusion

Frailty may be more accurate than advanced patient age alone for prognostication of adverse events and outcomes following intracranial meningioma resection.

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Data availability

All data utilized in this analysis are available upon reasonable request of the corresponding author following completion of necessary onboarding and verification procedures specified by the Healthcare Cost and Utilization Project.

Code availability

Billing codes utilized in this analysis are available upon reasonable request of the corresponding author. Those used for identification of primary clinical endpoints are defined in the manuscript supplement.

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Author information

Authors and Affiliations

  1. School of Medicine, New York Medical College, Valhalla, NY, 10595, USA

    Alis J. Dicpinigaitis

  2. Department of Neurosurgery, University of New Mexico, Albuquerque, NM, 87106, USA

    Syed Faraz Kazim, Meic H. Schmidt & Christian A. Bowers

  3. Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84132, USA

    William T. Couldwell

  4. Department of Neurosurgery, Yale University School of Medicine/Yale New Haven Hospital, New Haven, CT, 06510, USA

    Brianna Carusillo Theriault

  5. Department of Neurosurgery, Westchester Medical Center/New York Medical College, Valhalla, NY, 10595, USA

    Chirag D. Gandhi, Simon Hanft & Fawaz Al-Mufti

  6. Department of Neurosurgery, University of New Mexico Health Sciences Center, MSC10 5615, 1 University of New Mexico, Albuquerque, NM, 81731, USA

    Christian A. Bowers

Authors
  1. Alis J. Dicpinigaitis
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  2. Syed Faraz Kazim
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  3. Meic H. Schmidt
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  4. William T. Couldwell
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  5. Brianna Carusillo Theriault
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  6. Chirag D. Gandhi
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  7. Simon Hanft
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  8. Fawaz Al-Mufti
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  9. Christian A. Bowers
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Contributions

CAB and AJD conceived of the project and methodology. CAB, SFK, BCT, SFK, and SH composed the manuscript. AJD and SFK queried the database and completed statistical analysis. All authors interpreted the data and provided input on analysis and manuscript revision. All authors read and approved the final manuscript. CAB, FAM, WTC, MHS, and CDG provided supervision for the project.

Corresponding author

Correspondence to Christian A. Bowers.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Given the public accessibility and de-identified nature of the information in this database, this study did not meet the requirements for institutional review board approval. For the same reason, patient consent was neither sought nor required.

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Dicpinigaitis, A.J., Kazim, S.F., Schmidt, M.H. et al. Association of baseline frailty status and age with postoperative morbidity and mortality following intracranial meningioma resection. J Neurooncol 155, 45–52 (2021). https://doi.org/10.1007/s11060-021-03841-4

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  • DOI: https://doi.org/10.1007/s11060-021-03841-4

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