Meningioma resection in the elderly: nationwide inpatient sample, 1998-2002.
OBJECTIVE
Morbidity and mortality rates reported for meningioma resection in the elderly vary widely. Thus, it is difficult for neurosurgeons to compare the risks and benefits of operating on elderly patients against opting for radiosurgery or watchful waiting. To address this issue, we studied the effect of advanced age on outcome after meningioma resection using the Nationwide Inpatient Sample.


METHODS
We identified all patients over the age of 20 in the Nationwide Inpatient Sample database who underwent surgical resection of a meningioma between 1998 and 2002 and were admitted from home. Primary outcomes were in-hospital mortality, adverse outcome (defined as death or discharge to a facility other than home), and length of hospitalization. Multivariate models were constructed to assess the effect of elderly age on the primary outcomes, adjusting for patient demographics, comorbid medical conditions, and hospital surgical volume.


RESULTS
There were 8861 patients in the Nationwide Inpatient Sample database who underwent resection of meningioma during the study period; 26.0% were age 70 or older. Each of the primary outcomes demonstrated a marked effect of advancing age. The in-hospital mortality rate was higher in the elderly than in the nonelderly (4.0% versus 1.1%, P < 0.001), as was the rate of discharge to a facility other than home (53.2% versus 16.6%, P < 0.001). Elderly patients also had a longer mean length of stay (7.2 versus 5.1 d P < 0.001).


CONCLUSIONS
The association between elderly age and adverse outcome after meningioma resection suggests a note of caution before proceeding to surgery with these patients.
Bateman
Brian T
BT
College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. mfb1@columbia.edu
Pile-Spellman
John
J
Gutin
Philip H
PH
Berman
Mitchell F
MF
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008577:Meningeal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008579:Meningioma / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome