Impact of patient frailty on outcome after resection of non-skull-base meningiomas

PURPOSE: Surgery offers potential cure from meningioma. Non-skull-base meningiomas (NSBM) may cause mass effect, focal deficits or epilepsy and require surgical resection. The role of comorbidities and frailty on the clinical course after resection of brain tumors is an ongoing topic and needs further investigation. METHODS: Patients with histologically confirmed NSBM were evaluated in a single-center retrospective study. Clinical examinations, imaging studies, histopathology, 5- and 11-item modified frailty index (mFI-5/mFI-11), the Charlson Comorbidity Index (CCI), the American Society of Anesthesiologists risk classification (ASA) and the Eastern Cooperative Oncology Group (ECOG) performance status were evaluated. Primary endpoint was the ability to be discharged home. Secondary endpoints were length of postoperative stay, length of intensive care unit stay and complications. RESULTS: One-hundred-and-twenty patients (61.7% female) were evaluated. Median age at surgery was 61 (IQR 21.8) years, median tumor volume was 23.1 (IQR 51.2) cm³, median edema volume was 3.5 (IQR 26.0) cm³. Ninety-nine (82.5%) were discharged home. Risk factors for non-home discharge were increasing patient age (p < 0.001), larger tumor volume (p = 0.012), greater edema volume (p = 0.002), greater CCI (p < 0.001), greater mFI-5 (p < 0.001) and mFI-11 (p < 0.001). Length of postoperative stay correlated with age (rs = 0.43, p < 0.001), tumor volume (rs = 0.57, p < 0.001), edema volume (rs = 0.44, p < 0.001), preoperative midline shift (rs = 0.39, p < 0.001) and frailty (mFI-5: rs = 0.34, p < 0.001; mFI-11: rs = 0.34, p < 0.001). CONCLUSION: Frailty and chronological age have a significant impact on outcome of patients with non-skull-base meningiomas. Especially in large-volume tumors, age and frailty significantly increase the risk of a complicated postoperative course and prolongs the postoperative stay.