Surgical outcomes in octogenarian meningioma patients: a multicenter retrospective analysis of frailty and radiological predictors : Frailty in octogenarians undergoing meningioma resection.

Background: The rising life expectancy has led to an increased incidence of meningiomas among the elderly. In octogenarians, surgical decision-making remains particularly challenging due to frailty, comorbidities, and the risk of postoperative decline. This study investigates whether preoperative frailty indices and radiological features predict surgical outcomes in this high-risk population.

Methods: A multicenter retrospective cohort study was conducted across ten Spanish tertiary care centers, including 189 patients aged ≥ 80 years who underwent intracranial meningioma resection between 2010 and 2023. Preoperative variables included the 5-item Frailty Index (5-FI), Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) classification, and tumor-specific imaging characteristics (tumor diameter, peritumoral edema, and venous sinus involvement). The primary endpoint was the occurrence of Unfavorable Outcome (any postoperative neurological deficit, 30-day mortality, or major complication). Secondary endpoints included variation of KPS score at 1 year, discharge disposition, and 1-year mortality. Both univariate and multivariate logistic regression models were applied.

Results: Mean patient age was 83.0 ± 2.6 years, with 58.2% females. In univariate analysis, preoperative KPS < 70, higher WHO grade, and larger tumor diameter were associated with an unfavorable outcome. However, multivariate analysis identified only preoperative KPS < 70 as an independent predictor of worse outcome (OR 3.10, 95% CI 1.44-6.68, p = 0.004). At 12 months, functional status declined significantly (mean KPS from 73.5 to 63.5; p < 0.001), although 27.1% of patients remained functionally independent. New neurological deficits occurred in 23.8%, postoperative complications in 42.8%, and 30-day mortality was 4.2%. One-year mortality reached 15.8%. Predictors of 12-month KPS < 70 included higher age, preoperative KPS < 70, higher 5-FI, higher ASA grade, higher WHO grade, and the presence of major postoperative complications or new neurological deficits. In multivariate analysis, preoperative KPS < 70 (OR 14.45, 95% CI 5.64-37.03, p < 0.001) and the occurrence of new neurological deficits (OR 4.79, 95% CI 1.59-14.38, p = 0.005) were independent predictors of 12-month KPS < 70.

Conclusions: In octogenarians undergoing meningioma surgery, frailty indices-especially low preoperative KPS-and tumor-related characteristics are stronger predictors of surgical outcomes than age alone. Incorporating individualized assessments of physiological reserve and tumor burden may improve surgical planning and preoperative counseling in this growing patient population.