Predictors of Nonroutine Discharge Disposition Among Patients with Parasagittal/Parafalcine Meningioma

Adrian E. Jimenez, Adham M. Khalafallah, Sakibul Huq, Melanie A. Horowitz, Omar Azmeh, Shravika Lam, Leonardo A.P. Oliveira, Henry Brem, Debraj Mukherjee

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Discharge disposition is an important outcome for neurosurgeons to consider in the context of high-quality, value-based care. There has been limited research into how the unique anatomic considerations associated with parasagittal/parafalcine meningioma resection may influence discharge disposition. We investigated the effects of various predictors on discharge disposition within a cohort of patients with parasagittal/parafalcine meningioma. Methods: A total of 154 patients treated at a single institution were analyzed (2016–2019). Bivariate analysis was conducted using the Mann-Whitney U and Fisher exact tests. Multivariate analysis was conducted using logistic regression. An optimism-corrected C-statistic was calculated using 2000 bootstrap samples to assess logistic regression model performance. Results: Our cohort was mostly female (67.5%) and white (72.7%), with a mean age of 57.29 years. Most patients had tumors associated with the middle third of the superior sagittal sinus (SSS) (60.4%) and had tumors that were not fully occluding the SSS (74.0%). In multivariate analysis, independent predictors of nonroutine discharge disposition included 5-factor Modified Frailty Index score (odds ratio [OR], 2.06; P = 0.0088), Simpson grade IV resection (OR, 4.22; P = 0.0062), and occurrence of any postoperative complication (OR, 2.89; P = 0.031). The optimism-corrected C-statistic of our model was 0.757. Conclusions: In our single-institution experience, neither extent of SSS invasion nor location along the SSS predicted nonroutine discharge, suggesting that tumor invasion and posterior location along the SSS are not necessarily contraindications to surgery. Our results also highlight the importance of frailty and tumor size in stratifying patients at risk of nonroutine discharge disposition.

Original languageEnglish (US)
Pages (from-to)e344-e349
JournalWorld neurosurgery
Volume142
DOIs
StatePublished - Oct 2020

Keywords

  • Meningioma
  • Neuro-oncology
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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