Introduction: Appropriate patient selection for elective meningioma resection is a difficult challenge. There is an understandable reluctance to operate in cases with a high risk of postoperative deterioration. Increased age has repeatedly been implicated as a predictor of increased morbidity and mortality (1-3). However, a number of studies highlight comparable outcomes in the elderly population (4-6). We sought to analyze perioperative changes in performance status as a function of age.

Methods: We conducted a retrospective cohort study on 265 patients who underwent primary meningioma resection at our institution between 2001-2013. The medical records were used to assign Karnofsky Performance Status (KPS) scores both preoperatively and postoperatively. Latest preoperative clinic or ED presentations were used to estimate the preoperative KPS. Postoperative KPS was assigned at the first outpatient clinic visit. Patients were stratified into three groups: young, middle, and elderly based on age at the time of operation of <40, 40-75, or over 75 years respectively. Mean KPS changes were compared via student’s t-test and Fisher’s exact test was utilized to compare differences between categorical groups.

Results: Mean change in KPS after resection was +4.30 in the middle group. The young and elderly groups experienced a change of +8.81 and –5.83 respectively which differed significantly from the middle group (p=0.039, p<0.0001 respectively) Table 1, Figure 1. The elderly group also differed significantly from the middle group in rates of postoperative improvement (25.0% vs 50.8%, p=0.018) and deterioration (50% vs 8.0%, p<0.0001). Preoperative KPS was not significantly different amongst the three groups and likely not a confounder.

Conclusions: Perioperative improvement in performance status is more profound in patients below the age of 40. Patients above the age of 75 are at increased risk of postoperative deterioration and this should be carefully considered before proposing resection of a meningioma in this subgroup.

Patient Care: Appropriate patient selection for elective meningioma resection is a difficult challenge. This challenge is particularly evident amongst the elderly population where the current literature has somewhat conflicting reports regarding these patients’ rates of morbidity and mortality relative to their younger counterparts. Our research shows very strong evidence that patients over the age of 75 not only have poorer outcomes after meningioma resection than younger patients, but in fact can expect an average decrease in performance status postoperatively. Hence, our research supports increased caution and more stringent selection for an operation amongst elderly patients with meningiomas. Our data also show higher average increases in performance status postoperatively in patients below the age of 40 than those 40-75 years old. This supports recent and current patient selection amongst young individuals for meningioma resection as they can expect clinically minor, but statistically significant, better outcomes than their older counterparts.

Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of age as a predictor for changes of performance status in patients undergoing meningioma resection, discuss in small groups the importance of careful patient selection for such operations, and identify concerning postoperative morbidity in the recent population of elderly patients who have undergone meningioma resection.

References: 1. Patil CG, Veeravagu A, Lad SP, Boakye M. Craniotomy for resection of meningioma in the elderly: a multicentre, prospective analysis from the National Surgical Quality Improvement Program. J Neurol Neurosurg Psychiatr. 2010;81(5):502-5. 2. Bartek J, Sjåvik K, Förander P, et al. Predictors of severe complications in intracranial meningioma surgery: a population-based multicenter study. World Neurosurg. 2015; 3. Konglund A, Rogne SG, Lund-johansen M, Scheie D, Helseth E, Meling TR. Outcome following surgery for intracranial meningiomas in the aging. Acta Neurol Scand. 2013;127(3):161-9. 4. Boviatsis EJ, Bouras TI, Kouyialis AT, Themistocleous MS, Sakas DE. Impact of age on complications and outcome in meningioma surgery. Surg Neurol. 2007;68(4):407-11. 5. Poon MT, Fung LH, Pu JK, Leung GK. Outcome comparison between younger and older patients undergoing intracranial meningioma resections. J Neurooncol. 2013;114(2):219-27. 6. Grossman R, Mukherjee D, Chang DC, et al. Preoperative charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg. 2011;75(2):279-85.