Frailty Does Not Impact Postoperative Outcomes in Extended Endonasal Approaches for Olfactory Groove Meningiomas Compared with Open Craniotomy

Introduction: Frailty metrics have become a means of capturing a patient’s ability to tolerate the stressors of operative intervention and subsequent risk of poor postoperative outcomes. The objective of this study was to assess the impact of frailty in patients undergoing open and endoscopic resection of olfactory groove meningiomas.

Methods: A retrospective review was conducted of patients undergoing either open or endoscopic resection of olfactory groove meningiomas from 2018 to 2022. Demographic, intraoperative, postoperative, and survival data were collected, including postoperative complications, lengths of stay, return to operating room, and 30 readmission. Validated indices such as the Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) classification, and modified 5-item frailty index (mFI-5) were recorded to assess patient frailty. Multivariate logistic regression models with odds ratio (OR) as the outcome measure were calculated using R. Statistically significant predictors (p < 0.05) for multivariate analysis were determined via univariate analysis.

Results: Nineteen patients were included in the study, 6 of which underwent extended endoscopic resection and 13 of which underwent open craniotomy for resection. 14 patients were female (73.7%), 11 were white (57.9%), and the average age was 57.7 years. Most patients had an ASA of 3 (n = 11, 57.9%) with an average preoperative KPS of 76.3 and a postoperative KPS of 80.5. Average CCI was higher for open cases (2.69) than for endoscopic cases (1.5); average ASA for both cohorts was 2.5. There was a significant difference in postoperative complications (p < 0.001) between open and endoscopic cases, with open craniotomy cases including one mortality, one patient returning to the operating room for repair of postoperative cerebrospinal fluid leak (CSF), 3 with postoperative vision changes, and 2 with 30-day readmissions. No complications were encountered in the endoscopically treated patients. When looking at open cases, a prior history of cranial radiation was associated with a higher rate of postoperative complication (p = 0.057). Importantly, there was no significant difference in frailty between patients undergoing open and endoscopic cases, and in both scenarios, complications were not associated with ASA, CCI, or mFI-5. Length of stay (LOS) was significantly longer in open craniotomy patients, with 8 patients having LOS longer than 7 days. Lower preoperative functional status (OR: 2.00, 95% CI: 1.26–3.16, p = 0.0224), a higher preoperative CCI (OR: 2.21, 95% CI: 1.26–3.88, p = 0.0265), and age (OR: 2.36, 95% CI: 1.45–3.86, p = 0.0276) were associated with longer LOS.

Conclusion: When assessing patients who underwent open and endoscopic resections for olfactory groove meningiomas, accepted frailty metrics were not associated with postoperative complications or poor neurologic outcome. Poorer ASA, CCI, and preoperative functional status were associated with longer LOS. Prior history of cranial radiation was associated with complications in open cases, suggesting a need to revisit traditionally accepted frailty measures.

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

Publication History

Article published online:
05 February 2024