Surgical Risk in Elderly Patients with Meningiomas in Japan

TL;DR

The study examines surgical risks in elderly Japanese patients with meningiomas, finding that advanced age increases functional decline but not mortality, suggesting potential for recovery with proper care.

Contribution

The study provides novel insights into surgical risk factors specific to elderly patients with meningiomas using a national Japanese database.

Findings

Advanced age is a significant risk factor for functional decline (BI deterioration) but not in-hospital mortality.

Lower Barthel Index (60–80) increases BI deterioration risk in all age groups, while BI < 60 shows reduced risk in the elderly.

Tumor location and anticoagulant use are not significant risk factors for elderly patients (≥75 years).

Abstract

Background/Objective: No guidelines indicate surgical risk factors for the elderly because of the lack of data from general neurosurgeons. To better understand the management of surgical risk in elderly patients with meningiomas based on a national database in Japan. Methods: Results of surgically treated meningiomas were explored in 8138 patients registered in the Diagnosis Procedure Combination database in Japan during 2010–2015. Age (<65, 65–74, and ≥75 years), sex, Barthel index (BI), medical history, tumor location, oral medication prescriptions on admission, and stroke complications were evaluated. Multivariate logistic regression analysis identified risk factors for stroke complications, BI deterioration between admission and discharge, and in-hospital mortality. Results: Advanced age was the prominent risk factor for BI deterioration (odds ratio: 3.26; 95% confidence interval: 2.69–3.95) but not for in-hospital mortality. Lower BI (60–80) on admission increased the risk of BI deterioration in all age groups; however, BI < 60 demonstrated a significant inverse risk (0.47; 0.32–0.69) in the elderly (≥75 years). Location (falx, parasagittal, and deep) and anticoagulants were not significant risk factors for BI deterioration in patients aged ≥ 75 years, despite being significant risk factors in patients aged <65 and/or 65–74 years. Conclusions: Although advanced age could lead to postoperative functional decline at discharge, it was not sufficiently significant enough to be associated with in-hospital mortality. Because of the possibility of recovery even in elderly patients with severe disabilities, appropriate surgical selection and optimal management may lead to favorable functional outcomes in elderly patients with meningiomas.

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