EPID-10. An integrated, multi-database (SEER, NSQIP, NRD, SEER-Medicare, and NCDB) investigation of surgical resection of benign meningioma in octogenarians

Abstract BACKGROUND Despite its potential for more precise risk assessment, the frailty index is underutilized in real-world practice, with age still a key consideration in surgical decisions. Surgical decision-making in octogenarians with meningiomas, a benign brain cancer, is challenging in this context. Here, we characterized the clinical practice pattern, morbidity, and mortality associated with benign meningioma resection in octogenarians using: 1) Surveillance, Epidemiology and End Results (SEER), 2) National Surgical Quality Improvement Program (NSQIP), 3) National Readmission Database (NRD), 4) SEER-Medicare (SEER-M) and 5) National Cancer Database (NCDB). METHODS Logistic regression and propensity-score matching (PSM)-method (covariates balanced using PSM: socio-demographics, facility features, and comorbidities). RESULTS In SEER, the adjusted odds ratios (aOR) of recommendation for resection of meningioma was 0.17 (95% CI:0.15-0.21, p<0.001) for patients age ≥80 relative to age 40-59. Such a difference was not detected for malignant meningioma patients. In NSQIP, although the unadjusted odds ratio (OR) indicated higher risk for major complications and extended hospital stays for octogenarians than those under 80, these differences were no longer significant after adjusting for American Society of Anesthesiologists (ASA) class. In the NRD, age ≥ 80 was associated with increased odds of 90-day medical readmission after meningioma resection (aOR: 1.63, 95%CI:1.33-1.99) but not 90-day neurologic readmission (aOR: 1.02, 95%CI:0.76-1.37). In SEER-M, likelihood of death after benign meningioma resection was not significantly elevated in patients age ≥ 80 relative to age- and PSM-matched cancer-free patient cohorts (ROR:0.89, p=0.512). In NCDB, likelihood of death after benign meningioma resection was not significantly elevated in patients age ≥ 80 relative to age- and PSM-matched patients who underwent curative resection of papillary thyroid cancer (RHR:0.87, p=0.143). CONCLUSION The real-world data suggests that patients aged ≥ 80 selected for and underwent resection showed no significant increase in risk of post-operative morbidity, extended hospital stay, 90-day neurologic readmission, and subsequent mortality.