Department of Neurosurgery, Johns Hopkins School of Medicine, Neuro-Oncology Surgical Outcomes Research Laboratory, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2011 Feb;75(2):279-85. doi: 10.1016/j.wneu.2010.09.003.
Preoperative determinants of surgical risk in elderly patients with meningioma are not fully defined. This study was undertaken to determine whether the Charlson comorbidity index could be used to accurately predict postoperative outcomes among older patients with meningiomas undergoing neurosurgical resection and thereby make a selection for surgery easier.
We performed a multi-institutional retrospective cohort analysis via the Nationwide Inpatient Sample (1998-2005). Patients 65 years of age and older who underwent tumor resection of intracranial meningiomas were identified by International Classification of Diseases, 9th revision, coding. The primary independent variable in multivariate regression was the Charlson comorbidity score, and the primary outcome was inpatient death. Secondary outcomes included inpatient complications, length of stay, and total hospital charges.
We identified 5717 patients (66.6% female, and 81.8% white) with mean age of 73.6 years. Mean Charlson comorbidity score was 0.99. Inpatient mortality was 3.2%. Mean length of stay was 9.1 days, and mean total charges were $62,983. In multivariate analysis, the only factors consistently associated with worse outcome were increased Charlson comorbidity score and increased patient age (ie, >65 years of age). Only greater Charlson scores were additionally associated with greater odds of all major complications such as neurological, respiratory, and cardiac complications. Elective procedures were consistently associated with less inpatient death, length of stay, and total charges. All associations were statistically significant (P < 0.05).
The safe surgical resection of intracranial meningiomas among older patients is possible through the ninth decade of life. The Charlson comorbidity score has been shown to be a strong, consistent predictor of inpatient outcomes.
脑膜瘤老年患者的手术风险的术前决定因素尚未完全明确。本研究旨在确定 Charlson 合并症指数是否可用于准确预测接受神经外科切除术的老年脑膜瘤患者的术后结果，并使手术选择更容易。
我们通过全国住院患者样本（1998-2005 年）进行了多机构回顾性队列分析。通过国际疾病分类，第 9 版编码识别 65 岁及以上接受颅内脑膜瘤切除术的患者。多元回归的主要自变量是 Charlson 合并症评分，主要结果是住院内死亡。次要结果包括住院并发症、住院时间和总住院费用。
我们确定了 5717 名患者（66.6%为女性，81.8%为白人），平均年龄为 73.6 岁。平均 Charlson 合并症评分为 0.99。住院内死亡率为 3.2%。平均住院时间为 9.1 天，平均总费用为 62983 美元。在多变量分析中，唯一与较差结果一致相关的因素是 Charlson 合并症评分增加和患者年龄增加（即>65 岁）。只有更大的 Charlson 评分与更多主要并发症（如神经、呼吸和心脏并发症）的更高可能性相关。择期手术始终与住院内死亡、住院时间和总费用减少相关。所有关联均具有统计学意义（P <0.05）。
通过第九个十年的生活，对老年患者进行颅内脑膜瘤的安全手术切除是可能的。Charlson 合并症评分已被证明是住院结果的强有力且一致的预测因子。
