Older meningioma patients: a retrospective population-based study of risk factors for morbidity and mortality after neurosurgery

Abstract

Background: Meningioma is the most common primary CNS tumour. Most meningiomas are benign, and most patients are 65 years or older. Surgery is usually the primary treatment option. Most prior studies on early surgical outcomes in older patients with meningioma are small, and there is a lack of larger population-based studies to guide clinical decision-making. We aimed to explore the risks for perioperative mortality and morbidity in older patients with meningioma and to investigate changes in surgical incidence over time.

Methods: In this retrospective population-based study on patients in Sweden, 65 years or older with surgery 1999-2017 for meningioma, we used data from the Swedish Brain Tumour Registry. We analysed factors contributing to perioperative mortality and morbidity and used official demographic data to calculate yearly incidence of surgical procedures for meningioma.

Results: The final study cohort included 1676 patients with a 3.1% perioperative mortality and a 37.6% perioperative morbidity. In multivariate analysis, higher age showed a statistically significant association with higher perioperative mortality, whereas larger tumour size and having preoperative symptoms were associated with higher perioperative morbidity. A numerical increased rate of surgical interventions after 2012 was observed, without evidence of worsening short-term surgical outcomes.

Conclusions: Higher mortality with increased age and higher morbidity risk in larger and/or symptomatic tumours imply a possible benefit from considering surgery in selected older patients with a growing meningioma before the development of tumour-related symptoms. This study further underlines the need for a standardized method of reporting and classifying complications from neurosurgery.

Keywords: Elderly; Meningioma; Neurosurgical complications; Perioperative complications; Surgical complications.

Fig. 1

Study flowchart. Data selection and reasons for exclusion. £, as described in the Methods sections; #, date of surgery superseded by official date of death

Fig. 2

Population base and number of surgeries by year of surgery. N of persons age 65 years or older living in the studied healthcare regions and number of surgeries performed, incidence rate, OR for having surgery and corresponding p value by year of surgery. #, N of persons age 65 years or older (bars); ¤, N of surgeries performed (line); $, incidence rate of surgery per 100,000 for each year; £, OR for having surgery from univariate logistic regression with 1999 as index year. p value for the regression < 0.001