Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. Issue 5 (13th October 2009) - Patil, Chirag G
Abstract : Object: Whether there is an increased surgical risk in elderly patients who undergo craniotomy for meningioma resection remains a point of controversy. Utilising multicentre, prospective data from the National Surgical Quality Improvement Program, the present study sought to address this controversy. Methods: All patients who underwent a craniotomy for resection of intracranial meningioma (current procedural terminology codes 61512 and 61519) between 1997 and 2006 at 123 VA hospitals around the country were included. After controlling for preoperative factors such as ASA class, race, diabetes mellitus, disseminated cancer, tobacco use, tumour location and functional health status in a multivariate logistic regression model, the effect of elderly age (age greater than 70 years) on 30 day mortality was determined. Results: Our study included 1281 patients who underwent surgical resection of an intracranial meningioma. Although each VA completed a different number of operations, we are able to provide case volume data for approximately 60 of the 123 hospitals. The elderly cohort represented 21.2% (n=258) of our total study population. Elderly patients had a higher 30 day mortality (12.0%) than younger subjects (4.6%) (p<0.0001). Similarly, elderly patients were more likely to have one or more complications (29.8% vs 13.1%, p<0.0001). Multivariate logistic regression identified age, functional status, preoperative disseminated cancer and tumour location as important predictors of 30 day mortality. After controlling for preoperative comorbidities and risk factors, the odds of perioperative mortality in elderly patients were three times that of younger patients (OR 3.0, 95% CI 1.7 to 5.3, p=0.0102). Conclusion: After carefully controlling for various patient characteristics, ASA class and functional status, elderly patients have poorer outcome after surgical resection of intracranial meningioma than younger subjects.