title: Frailty in Geriatric Glioblastoma Patients: A Predictor of Operative Morbidity and Outcome.
abstract: BACKGROUND
  Frailty is an emerging means of assessing overall health status and guiding management for geriatric patients. Frailty is associated with outcomes for many surgical indications in this age group. While half of all glioblastoma patients are 65 years old or older, frailty has not been examined in relation to surgery for glioblastoma.
  
  
  METHODS
  We performed a retrospective study of patients age 65 years and older with pathologically confirmed glioblastoma at Columbia Presbyterian Hospital from 2000 to 2012; 319 patients were identified, 243 of whom underwent craniotomy for lobar lesions. Frailty was quantified using the Canadian Study of Health and Aging Modified Frailty Index. Postoperative complications were classified according the Glioma Outcomes Project system. Systemic, regional, neurologic, and overall complications were examined in relation to age, Karnofsky performance status, frailty, comorbid disease burden, cardiovascular risk, and tumor sidedness.
  
  
  RESULTS
  Frailer patients were less likely to undergo surgical resection (P = 0.0002; odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05-0.40) as opposed to biopsy, had longer hospital stays (log-rank test for trend, P = 0.0061), an increased overall risk of complications (P = 0.0123; OR, 1.40; 95% CI, 1.08-1.83), and decreased overall survival (Log rank test for trend, P = 0.0028).
  
  
  CONCLUSIONS
  Frailer patients with glioblastoma receive less aggressive intervention, have longer hospital stays, and experience more complications. Frailty may be an underused metric for the preoperative risk assessment of geriatric glioblastoma patients.
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, NY, USA; Columbia University Mailman School of Public Health, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Cloney
authors.affiliation: Columbia University Mailman School of Public Health, New York, NY, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Randy
authors.initials: R
authors.lastname: D'Amico
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, NY, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Lebovic
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, NY, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Nazarian
authors.affiliation: Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Brad E
authors.initials: BE
authors.lastname: Zacharia
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sisti
authors.affiliation: Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, NY, USA; Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
authors.affiliation: Division of Neurooncology, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Iwamoto
authors.affiliation: Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA. Electronic address: as3537@cumc.columbia.edu.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Sonabend
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity; D003399:Craniotomy; D016330:Frail Elderly; D015577:Geriatric Assessment; D005909:Glioblastoma / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Complications; Craniotomy; Frail; Frailty; Geriatric; Glioblastoma