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In-Hospital Complications After Surgery in Elderly Patients with Asymptomatic or Minor Symptom Meningioma: A
Fusao Ikawa1, Naoyuki Isobe2, Nobuaki Michihata3
1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
Background:
Asymptomatic or minor symptom meningiomas (AMSMs) in the elderly are incidental findings, with no consensus reached on the optimal management strategy. In the present study, we aimed to determine the surgical risk factors for elderly patients with AMSMs using a nationwide registry database in Japan.
Methods:
We identified patients with surgically treated AMSMs using the Diagnosis Procedure Combination database from 2010 to 2015 and reviewed the medical records for age (<65 years; pre-elderly, 65-74 years; and elderly, ≥75 years), sex, Barthel index (BI) score, medical history, tumor location, and complications. An AMSM was defined by a BI score of 100 points at admission. The risk factors for all stroke complications, BI deterioration at discharge, and in-hospital mortality were determined using multivariate logistic regression analyses.
Results:
From a total of 10,535 patients with meningioma, 6628 were included. Advanced age was a significant risk factor (odds ratio, 3.54; 95% confidence interval, 2.80-4.46) for BI deterioration but not for all-stroke complications or in-hospital mortality. Midline and posterior fossa tumors, diabetes mellitus, and chronic heart disease were significant risk factors for in-hospital mortality.
Conclusions:
For elderly patients with surgically treated AMSMs, advanced age was a prominent risk factor for functional decline at discharge. Our study identified several factors that should be evaluated before proceeding with surgery for AMSMs in elderly and pre-elderly patients. These findings could, not only improve decision-making among clinicians treating patients with AMSMs, but also help in predicting the results of surgery for elderly patients with AMSMs.
Insights
Advanced age is a significant risk factor for functional decline in elderly patients undergoing surgery for asymptomatic or minor symptom meningiomas (AMSMs). This study identifies key factors to evaluate before surgical intervention in older adults.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Oncology
Background:
- Asymptomatic or minor symptom meningiomas (AMSMs) in the elderly lack a consensus on optimal management.
- Incidental findings in older populations necessitate careful consideration of treatment strategies.
Purpose of the Study:
- To determine surgical risk factors for elderly patients with AMSMs.
- To identify predictors of adverse outcomes following surgery for AMSMs in older adults.
Main Methods:
- Utilized the Diagnosis Procedure Combination database (2010-2015) in Japan for surgically treated AMSMs.
- Analyzed patient data including age, Barthel index (BI) score, medical history, tumor location, and complications.
- Employed multivariate logistic regression to assess risk factors for stroke, BI deterioration, and mortality.
Main Results:
- Advanced age (≥75 years) significantly predicted Barthel index (BI) deterioration (OR 3.54).
- Midline and posterior fossa tumors, diabetes mellitus, and chronic heart disease were associated with in-hospital mortality.
- Advanced age did not significantly increase risks for stroke complications or in-hospital mortality.
Conclusions:
- Advanced age is a critical risk factor for functional decline after AMSM surgery in the elderly.
- Identifying pre-operative risk factors is crucial for surgical decision-making and outcome prediction in elderly AMSM patients.
- Findings aid clinicians in evaluating surgical risks and managing AMSMs in older populations.
