The prognostic role of frailty on outcomes following meningioma resection in the elderly: a matched analysis employing baseline functional status.

INTRODUCTION

Meningioma resection constitutes a substantial portion of neurosurgical practice, with a variety of patient-factors playing a role in outcomes. This study aims to assess the role of frailty in elderly patients undergoing resection of primary intracranial meningiomas.

METHODS

This is a retrospective study of patients undergoing resection for primary intracranial meningiomas at our institution between 2004-2024. Patients were ≥ 65 years, and were required to have ≥ 1 year of follow-up. The modified frailty index (mFI) was used to identify degree of frailty, categorising patients into the non-frail (NF, mFI = 0), pre-frail (PF, mFI = 1/2), and frail (F, mFI ≥ 3) groups. The Shapiro-Wilk test, paired T-test, and ANOVA were used to identify statistical significance. Propensity-score matching (PSM) was performed based on a multinomial logistic regression model and 1:1 nearest-neighbour matching algorithm. Kaplan-Meier analysis using Log-rank tests were used to compare overall (OS) and progression-free (PFS) survival.

RESULTS

362 patients were included, with 69, 207, and 86 patients in the NF, PF, and F groups respectively. Preoperatively, the F group was found to have a significantly higher age vs. the NF group (76.17 vs. 71.57, p = 0.0002), alongside reporting a significantly lower median KPS vs. the PF and NF groups (70 vs. 80, p < 0.0001) respectively. The PF group was found to have a significantly lower duration of surgery (309 min, p = 0.0048) vs. the F group, which reported significantly higher mean length-of-stay (17.68 days, p < 0.0001), higher frequencies of medical complications (11.6%, p = 0.0317), and lower postoperative KPS (70, p < 0.0001) vs. other groups. Despite PSM, the F group was found to have significantly reduced median OS (p = 0.0106) and PFS (p = 0.0101) compared to other groups.

CONCLUSION

Frailty was significantly associated with higher length-of-stay, frequent medical complications, and worse OS and PFS following surgery vs. other groups. Frailty is hence a crucial consideration in preoperative planning for elderly populations undergoing meningioma resection.