The Impact of Patient Frailty on Hospital Stay and Discharge Disposition following Surgical Resection in Patients with High-Grade Meningiomas

Introduction: The current treatment paradigm for World Health Organization (WHO) grade II and III meningioma is maximum safe surgical resection, often with postsurgical adjunctive radiotherapy. Important postoperative considerations in these patients include length of stay (LOS) and discharge disposition. Since the association between prolonged LOS and hospital-associated complications, such as infection and patient falls, is well documented, timely discharge is important to minimize the risks associated with protracted hospitalization. The level of continued care required at discharge determines the disposition and has been used as a proxy for postoperative patient clinical status. In older patients with meningiomas, the impact of frailty on LOS and discharge disposition becomes an especially important question. In this study, we assessed the impact of frailty measures on LOS and discharge disposition in patients with high-grade meningiomas.

Methods: A retrospective review was performed of patients with WHO II and III meningiomas who underwent surgical resection at our institution between 1995 and 2019. Data collected included patient demographics, Clinical Frailty Index (CFI), Charlson’s comorbidity index (CCI), surgical parameters, postoperative hospital course, and discharge disposition. Univariate and multivariate analyses were performed to determine parameters significantly associated with LOS and discharge disposition. The best-fit model for predicting discharge disposition based on patient and tumor-specific parameters was determined via a logistic regression analysis informed by Akaike information criteria (AIC), with the outcome designated as discharge to home versus facility, which included SNF, acute rehab, and LTAC.

Results: A total of 235 patients were included in the final analysis. One-hundred thirty-one patients (55.7%) were female and 104 patients (44.3%) were male. Black race and age were identified on multivariate analysis to be significantly correlated with increased LOS (p < 0.001 for both). With respect to disposition,166 patients (70.6%) were discharged to home, and 69 patients (29.4%) were discharged to facility. Three parameters were significantly associated on multivariate analysis with discharge to a facility: (1) age at time of surgery (66.5 ± 15.9 years for AOH vs. 59.6 ± 13.4 years for home, p < 0.001), (2) CFI (4.16 ± 1.53 for facility vs. 3.46 ± 0.98 for home, p < 0.001), and (3) CCI (5.34 ± 1.76 for AOH vs. 4.12 ± 1.80 for home, p < 0.001). The logistic regression model that yielded the minimum AIC was selected as the final model and included age (OR = 1.59, p = 0.0012), black race (OR = 0.26, p = 0.029), and CFI (OR = 1.39, p = 0.032) as the most significant predictors of discharge to facility.

Conclusion: Clinical frailty (as assessed by CFI), CCI, and age, were significantly correlated with discharge to facility after surgical resection in patients with high-grade meningiomas in this study. CFI and age were selected as significant predictors of discharge to facility and age was the only significant predictor for increased LOS in best-fit logistic regression models. Clinical frailty parameters may help guide preoperative optimization and counseling in patients with high-grade meningiomas.

No conflict of interest has been declared by the author(s).