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07.05.2024 | Research

Frailty in intracranial meningioma resection: the risk analysis index demonstrates strong discrimination for predicting non-home discharge and in-hospital mortality

verfasst von: Michael M. Covell, Joanna M. Roy, Nithin Gupta, Ahmed Sami Raihane, Kranti C. Rumalla, Amanda Cyntia Lima Fonseca Rodrigues, Evan Courville, Christian A. Bowers

Erschienen in: Journal of Neuro-Oncology | Ausgabe 1/2024

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Abstract

Purpose

Frailty is an independent risk factor for adverse postoperative outcomes following intracranial meningioma resection (IMR). The role of the Risk Analysis Index (RAI) in predicting postoperative outcomes following IMR is nascent but may inform preoperative patient selection and surgical planning.

Methods

IMR patients from the Nationwide Inpatient Sample were identified using diagnostic and procedural codes (2019–2020). The relationship between preoperative RAI-measured frailty and primary outcomes (non-home discharge (NHD), in-hospital mortality) and secondary outcomes (extended length of stay (eLOS), complication rates) was assessed via multivariate analyses. The discriminatory accuracy of the RAI for primary outcomes was measured in area under the receiver operating characteristic (AUROC) curve analysis.

Results

A total of 23,230 IMR patients (mean age = 59) were identified, with frailty statuses stratified by RAI score: 0–20 “robust” (R)(N = 10,665, 45.9%), 21–30 “normal” (N)(N = 8,895, 38.3%), 31–40 “frail” (F)(N = 2,605, 11.2%), and 41+ “very frail” (VF)(N = 1,065, 4.6%). Rates of NHD (R 11.5%, N 29.7%, F 60.8%, VF 61.5%), in-hospital mortality (R 0.5%, N 1.8%, F 3.8%, VF 7.0%), eLOS (R 13.2%, N 21.5%, F 40.9%, VF 46.0%), and complications (R 7.5%, N 11.6%, F 15.7%, VF 16.0%) significantly increased with increasing frailty thresholds (p < 0.001). The RAI demonstrated strong discrimination for NHD (C-statistic: 0.755) and in-hospital mortality (C-statistic: 0.754) in AUROC curve analysis.

Conclusion

Increasing RAI-measured frailty is significantly associated with increased complication rates, eLOS, NHD, and in-hospital mortality following IMR. The RAI demonstrates strong discrimination for predicting NHD and in-hospital mortality following IMR, and may aid in preoperative risk stratification.

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Rockhill J, Mrugala M, Chamberlain MC (2007) Intracranial meningiomas: an overview of diagnosis and treatment. Neurosurg Focus 23:E1. https://doi.org/10.3171/FOC-07/10/E1CrossRefPubMed

İldan F, Erman T, Göçer Aİ, Tuna M, Bağdatoğlu H, Çetinalp E et al (2007) Predicting the Probability of Meningioma recurrence in the preoperative and early postoperative period: a multivariate analysis in the Midterm Follow-Up. Skull Base 17:157–171. https://doi.org/10.1055/s-2007-970554CrossRefPubMedPubMedCentral

Maier AD, Meddis A, Mirian C, Haslund-Vinding J, Bartek J, Krog SM et al (2023) Gene expression analysis during progression of malignant meningioma compared to benign meningioma. J Neurosurg 138:1302–1312. https://doi.org/10.3171/2022.7.JNS22585CrossRefPubMed

Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK et al (2016) The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol 131:803–820. https://doi.org/10.1007/s00401-016-1545-1CrossRefPubMed

Porter KR, McCarthy BJ, Freels S, Kim Y, Davis FG (2010) Prevalence estimates for primary brain tumors in the United States by age, gender, behavior, and histology. Neuro Oncol 12:520–527. https://doi.org/10.1093/neuonc/nop066CrossRefPubMedPubMedCentral

Chamoun R, Krisht KM, Couldwell WT (2011) Incidental meningiomas. NeuroSurg Focus 31:E19. https://doi.org/10.3171/2011.9.FOCUS11220CrossRefPubMed

Oakland K, Nadler R, Cresswell L, Jackson D, Coughlin PA (2016) Systematic review and meta-analysis of the association between frailty and outcome in surgical patients. Ann R Coll Surg Engl 98:80–85. https://doi.org/10.1308/rcsann.2016.0048CrossRefPubMedPubMedCentral

Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I (2013) Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res 183:104–110. https://doi.org/10.1016/j.jss.2013.01.021CrossRefPubMed

Theriault BC, Pazniokas J, Adkoli AS, Cho EK, Rao N, Schmidt M et al (2020) Frailty predicts worse outcomes after intracranial meningioma surgery irrespective of existing prognostic factors. NeuroSurg Focus 49:E16. https://doi.org/10.3171/2020.7.FOCUS20324CrossRefPubMed

10.

Isobe N, Ikawa F, Tominaga A, Kuroki K, Sadatomo T, Mizoue T et al (2018) Factors related to Frailty Associated with Clinical Deterioration after Meningioma surgery in the Elderly. World Neurosurg 119:e167–e173. https://doi.org/10.1016/j.wneu.2018.07.080CrossRefPubMed

11.

Hall DE, Arya S, Schmid KK, Blaser C, Carlson MA, Bailey TL et al (2017) Development and initial validation of the risk analysis index for measuring Frailty in Surgical populations. JAMA Surg 152:175–182. https://doi.org/10.1001/jamasurg.2016.4202CrossRefPubMedPubMedCentral

12.

Bonney PA, Chartrain AG, Briggs RG, Jarvis CA, Ding L, Mack WJ et al (2021) Frailty is Associated with In-Hospital morbidity and Nonroutine Disposition in Brain Tumor patients undergoing craniotomy. World Neurosurg 146:e1045–e1053. https://doi.org/10.1016/j.wneu.2020.11.083CrossRefPubMed

13.

Thommen R, Kazim SF, Rumalla K, Kassicieh AJ, Kalokoti P, Schmidt MH et al (2022) Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis. J Neurooncol. https://doi.org/10.1007/s11060-022-04135-zCrossRefPubMed

14.

Ikawa F, Michihata N, Oya S, Hidaka T, Ohata K, Saito K et al (2022) A nationwide registry study: the 5-factor modified frailty index of meningioma surgery in non-elderly and elderly patients. Clin Neurol Neurosurg 222:107445. https://doi.org/10.1016/j.clineuro.2022.107445CrossRefPubMed

15.

Traven SA, Reeves RA, Althoff AD, Slone HS, Walton ZJ (2019) New five-factor modified Frailty Index predicts morbidity and mortality in geriatric hip fractures. J Orthop Trauma 33:319–323. https://doi.org/10.1097/BOT.0000000000001455CrossRefPubMed

16.

Huq S, Khalafallah AM, Jimenez AE, Gami A, Lam S, Ruiz-Cardozo MA et al (2020) Predicting Postoperative outcomes in Brain Tumor patients with a 5-Factor modified Frailty Index. Neurosurgery 88:147–154. https://doi.org/10.1093/neuros/nyaa335CrossRefPubMedPubMedCentral

17.

Khalafallah AM, Huq S, Jimenez AE, Brem H, Mukherjee D (2020) The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients. J Neurosurg 135:78–86. https://doi.org/10.3171/2020.5.JNS20766CrossRefPubMed

18.

Wilson JRF, Badhiwala JH, Moghaddamjou A, Yee A, Wilson JR, Fehlings MG (2020) Frailty is a better predictor than age of mortality and perioperative complications after surgery for degenerative cervical myelopathy: an analysis of 41,369 patients from the NSQIP database 2010–2018. J Clin Med 9:3491. https://doi.org/10.3390/jcm9113491CrossRefPubMedPubMedCentral

19.

Torres-Perez P, Álvarez-Satta M, Arrazola M, Egaña L, Moreno-Valladares M, Villanua J et al (2021) Frailty is associated with mortality in brain tumor patients. Am J Cancer Res 11:3294–3303PubMedPubMedCentral

20.

Alruwaili AA, De Jesus O, Meningioma (2023) StatPearls, Treasure Island (FL): StatPearls Publishing

21.

Huq S, Liu J, Romano R, Seal S, Khalafallah AM, Walston JD et al (2022) Frailty in patients undergoing surgery for Brain tumors: a systematic review of the literature. World Neurosurg 166:268–278e8. https://doi.org/10.1016/j.wneu.2022.07.039CrossRefPubMed

22.

Zhu J, Qiu X, Ji C, Wang F, Tao A, Chen L (2023) Frailty as a predictor of neurosurgical outcomes in brain tumor patients: a systematic review and meta-analysis. Front Psychiatry 14:1126123. https://doi.org/10.3389/fpsyt.2023.1126123CrossRefPubMedPubMedCentral

23.

Covell MM, Warrier A, Rumalla KC, Dehney CM, Bowers CA (2023) RAI-measured frailty predicts non-home discharge following metastatic brain tumor resection: national inpatient sample analysis of 20,185 patients. J Neurooncol. https://doi.org/10.1007/s11060-023-04461-wCrossRefPubMed

24.

Skandalakis GP, Medani K, Rumalla K, Roy JM, Segura A, Zohdy YM et al (2023) Preoperative frailty and 30-day mortality after resection of brain metastases: a multicenter surgical registry analysis of 11,038 patients. NeuroSurg Focus 55:E8. https://doi.org/10.3171/2023.5.FOCUS23198CrossRefPubMed

25.

Partridge JSL, Harari D, Dhesi JK (2012) Frailty in the older surgical patient: a review. Age Ageing 41:142–147. https://doi.org/10.1093/ageing/afr182CrossRefPubMed

26.

Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210:901–908. https://doi.org/10.1016/j.jamcollsurg.2010.01.028CrossRefPubMed

27.

Achey RL, Gittleman H, Schroer J, Khanna V, Kruchko C, Barnholtz-Sloan JS (2019) Nonmalignant and malignant meningioma incidence and survival in the elderly, 2005–2015, using the Central Brain Tumor Registry of the United States. Neuro Oncol 21:380–391. https://doi.org/10.1093/neuonc/noy162CrossRefPubMed

28.

Apra C, Peyre M, Kalamarides M (2018) Current treatment options for meningioma. Expert Rev Neurother 18:241–249. https://doi.org/10.1080/14737175.2018.1429920CrossRefPubMed

29.

Nassiri F, Price B, Shehab A, Au K, Cusimano MD, Jenkinson MD et al (2019) Life after surgical resection of a meningioma: a prospective cross-sectional study evaluating health-related quality of life. Neurooncology 21:i32–43. https://doi.org/10.1093/neuonc/noy152CrossRef

30.

Nassiri F, Tabatabai G, Aldape K, Zadeh G (2019) Challenges and opportunities in meningiomas: recommendations from the International Consortium on meningiomas. Neuro Oncol 21:i2–3. https://doi.org/10.1093/neuonc/noy181CrossRefPubMedPubMedCentral

31.

Sheehan J, Pikis S, Islim AI, Chen C-J, Bunevicius A, Peker S et al (2022) An international multicenter matched cohort analysis of incidental meningioma progression during active surveillance or after stereotactic radiosurgery: the IMPASSE study. Neuro Oncol 24:116–124. https://doi.org/10.1093/neuonc/noab132CrossRefPubMed

32.

Bunevicius A, Anand RK, Suleiman M, Nabeel AM, Reda WA, Tawadros SR et al (2021) Stereotactic radiosurgery for perioptic meningiomas: an International, Multicenter Study. Neurosurgery 88:828–837. https://doi.org/10.1093/neuros/nyaa544CrossRefPubMedPubMedCentral

33.

Sastry RA, Pertsch NJ, Tang O, Shao B, Toms SA, Weil RJ (2020) Frailty and outcomes after craniotomy for brain tumor. J Clin Neurosci 81:95–100. https://doi.org/10.1016/j.jocn.2020.09.002CrossRefPubMed

34.

Kolakshyapati M, Ikawa F, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M et al (2018) Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma. Neurosurg Focus 44:E14. https://doi.org/10.3171/2018.1.FOCUS17730CrossRefPubMed

35.

Youngerman BE, Neugut AI, Yang J, Hershman DL, Wright JD, Bruce JN (2018) The modified frailty index and 30-day adverse events in oncologic neurosurgery. J Neurooncol 136:197–206. https://doi.org/10.1007/s11060-017-2644-0CrossRefPubMed

36.

Jimenez AE, Khalafallah AM, Huq S, Horowitz MA, Azmeh O, Lam S et al (2020) Predictors of Nonroutine Discharge Disposition among patients with Parasagittal/Parafalcine Meningioma. World Neurosurg 142:e344–e349. https://doi.org/10.1016/j.wneu.2020.06.239CrossRefPubMed

37.

Dicpinigaitis AJ, Kazim SF, Schmidt MH, Couldwell WT, Theriault BC, Gandhi CD et al (2021) Association of baseline frailty status and age with postoperative morbidity and mortality following intracranial meningioma resection. J Neurooncol 155:45–52. https://doi.org/10.1007/s11060-021-03841-4CrossRefPubMed

38.

Cole KL, Kazim SF, Thommen R, Alvarez-Crespo DJ, Vellek J, Conlon M et al (2022) Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015–2019. Eur J Surg Oncol 48:1671–1677. https://doi.org/10.1016/j.ejso.2022.02.015CrossRefPubMed

39.

Covell MM, Roy JM, Rumalla K, Dicpinigaitis AJ, Kazim SF, Hall DE et al (2023) The Limited Utility of the Hospital Frailty Risk Score as a Frailty Assessment Tool in Neurosurgery: A Systematic Review. Neurosurgery. https://doi.org/10.1227/neu.0000000000002668

40.

Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL et al (2017) Association of a Frailty Screening Initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg 152:233–240. https://doi.org/10.1001/jamasurg.2016.4219CrossRefPubMedPubMedCentral

41.

Conlon M, Thommen R, Kazim SF, Dicpinigaitis AJ, Schmidt MH, McKee RG et al (2022) Risk analysis index and its recalibrated Version Predict Postoperative outcomes Better Than 5-Factor modified Frailty Index in traumatic spinal Injury. Neurospine 19:1039–1048. https://doi.org/10.14245/ns.2244326.163CrossRefPubMedPubMedCentral

42.

Bowers CA, Varela S, Conlon M, Kazim SF, Thommen R, Roster K et al (2023) Comparison of the risk analysis index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery. J Neurosurg Spine 39:136–145. https://doi.org/10.3171/2023.2.SPINE221019CrossRefPubMed

43.

Ahmeti H, Borzikowsky C, Hollander D, Röcken C, Jansen O, Synowitz M et al (2021) Risks and neurological benefits of meningioma surgery in elderly patients compared to young patients. J Neurooncol 154:335–344. https://doi.org/10.1007/s11060-021-03832-5CrossRefPubMedPubMedCentral

44.

Ekaireb RI, Edwards CS, Ali MS, Nguyen MP, Daggubati V, Aghi MK et al (2021) Meningioma surgical outcomes and complications in patients aged 75 years and older. J Clin Neurosci 88:88–94. https://doi.org/10.1016/j.jocn.2021.03.032CrossRefPubMed

45.

Stonnington H, Shahbandi A, Bcharah G, Singh R, George DD, Furst T et al Timing and morbidity of Intracranial Meningioma Resection complications. World Neurosurg 2023:S1878-8750(23)01818-1. https://doi.org/10.1016/j.wneu.2023.12.084

46.

Reese JC, Twitchell S, Wilde H, Azab MA, Guan J, Karsy M et al (2019) Analysis of treatment cost variation among multiple neurosurgical procedures using the value-driven outcomes database. World Neurosurg 126:e914–e920. https://doi.org/10.1016/j.wneu.2019.03.010CrossRefPubMed

47.

Missios S, Bekelis K (2015) Drivers of hospitalization cost after craniotomy for tumor resection: creation and validation of a predictive model. BMC Health Serv Res 15:85. https://doi.org/10.1186/s12913-015-0742-2CrossRefPubMedPubMedCentral

48.

Poon MT-C, Fung LH-K, Pu JK-S, Leung GK-K (2013) Outcome comparison between younger and older patients undergoing intracranial meningioma resections. J Neurooncol 114:219–227. https://doi.org/10.1007/s11060-013-1173-8CrossRefPubMed

49.

Sharma M, Ugiliweneza B, Boakye M, Andaluz N, Williams BJ (2019) Feasibility of Bundled payments in Anterior, Middle, and posterior cranial Fossa Skull Base Meningioma surgery: MarketScan Analysis of Health Care utilization and outcomes. World Neurosurg 131:e116–e127. https://doi.org/10.1016/j.wneu.2019.07.078CrossRefPubMed

50.

Parasher AK, Lerner DK, Miranda SP, Douglas JE, Glicksman JT, Alexander T et al (2023) In-Hospital cost comparison for Open Versus Endoscopic Endonasal Approach for Meningioma Resection. Am J Rhinol Allergy 37:324–329. https://doi.org/10.1177/19458924221145893CrossRefPubMed

51.

Islim AI, Millward CP, Mills SJ, Fountain DM, Zakaria R, Pathmanaban ON et al (2023) The management of incidental meningioma: an unresolved clinical conundrum. Neurooncol Adv 5:i26–34. https://doi.org/10.1093/noajnl/vdac109CrossRefPubMedPubMedCentral

52.

Berthelsen CL (2000) Evaluation of coding data quality of the HCUP National Inpatient Sample. Top Health Inf Manage 21:10–23PubMed

Titel: Frailty in intracranial meningioma resection: the risk analysis index demonstrates strong discrimination for predicting non-home discharge and in-hospital mortality
verfasst von: Michael M. Covell
Joanna M. Roy
Nithin Gupta
Ahmed Sami Raihane
Kranti C. Rumalla
Amanda Cyntia Lima Fonseca Rodrigues
Evan Courville
Christian A. Bowers
Publikationsdatum: 07.05.2024
Verlag: Springer US
Erschienen in: Journal of Neuro-Oncology / Ausgabe 1/2024
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-024-04703-5

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Frailty in intracranial meningioma resection: the risk analysis index demonstrates strong discrimination for predicting non-home discharge and in-hospital mortality