TY - JOUR
T1 - Predictors of Nonroutine Discharge Disposition Among Patients with Parasagittal/Parafalcine Meningioma
AU - Jimenez, Adrian E.
AU - Khalafallah, Adham M.
AU - Huq, Sakibul
AU - Horowitz, Melanie A.
AU - Azmeh, Omar
AU - Lam, Shravika
AU - Oliveira, Leonardo A.P.
AU - Brem, Henry
AU - Mukherjee, Debraj
N1 - Funding Information:
Conflict of interest statement: The authors received no financial support for the research, authorship, and/or publication of this article. H.B. is a consultant for AsclepiX Therapeutics, StemGen, InSightec, Accelerating Combination Therapies, NexImmune, Camden Partners, LikeMinds Inc., Galen Robotics Inc., and Nurami Medical, and he receives support from Arbor Pharmaceuticals, Bristol-Myers Squibb, and AcuityBio Corp. for non–study-related clinical or research effort.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - 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.
AB - 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.
KW - Meningioma
KW - Neuro-oncology
KW - Outcomes
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U2 - 10.1016/j.wneu.2020.06.239
DO - 10.1016/j.wneu.2020.06.239
M3 - Article
C2 - 32652275
AN - SCOPUS:85088877199
SN - 1878-8750
VL - 142
SP - e344-e349
JO - World neurosurgery
JF - World neurosurgery
ER -