title: Preoperative charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients.
abstract: OBJECTIVE
  Preoperative determinants of surgical risk in elderly patients with meningioma are not fully defined. This study was undertaken to determine whether the Charlson comorbidity index could be used to accurately predict postoperative outcomes among older patients with meningiomas undergoing neurosurgical resection and thereby make a selection for surgery easier.
  
  
  METHODS
  We performed a multi-institutional retrospective cohort analysis via the Nationwide Inpatient Sample (1998-2005). Patients 65 years of age and older who underwent tumor resection of intracranial meningiomas were identified by International Classification of Diseases, 9th revision, coding. The primary independent variable in multivariate regression was the Charlson comorbidity score, and the primary outcome was inpatient death. Secondary outcomes included inpatient complications, length of stay, and total hospital charges.
  
  
  RESULTS
  We identified 5717 patients (66.6% female, and 81.8% white) with mean age of 73.6 years. Mean Charlson comorbidity score was 0.99. Inpatient mortality was 3.2%. Mean length of stay was 9.1 days, and mean total charges were $62,983. In multivariate analysis, the only factors consistently associated with worse outcome were increased Charlson comorbidity score and increased patient age (ie, >65 years of age). Only greater Charlson scores were additionally associated with greater odds of all major complications such as neurological, respiratory, and cardiac complications. Elective procedures were consistently associated with less inpatient death, length of stay, and total charges. All associations were statistically significant (P < 0.05).
  
  
  CONCLUSIONS
  The safe surgical resection of intracranial meningiomas among older patients is possible through the ninth decade of life. The Charlson comorbidity score has been shown to be a strong, consistent predictor of inpatient outcomes.
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Neuro-Oncology Surgical Outcomes Research Laboratory, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grossman
authors.forename: Debraj
authors.initials: D
authors.lastname: Mukherjee
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Richard
authors.initials: R
authors.lastname: Bennett
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008577:Meningeal Neoplasms / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D008579:Meningioma / Q000191:economics / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index