Frailty in Geriatric Glioblastoma Patients: A Predictor of Operative Morbidity and Outcome

Michael Cloney, Randy D'Amico, Jordan Lebovic, Matthew Nazarian, Brad Zacharia, Michael B. Sisti, Jeffrey N. Bruce, Guy M. McKhann, Fabio M. Iwamoto, Adam M. Sonabend

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background Frailty is an emerging means of assessing overall health status and guiding management for geriatric patients. Frailty is associated with outcomes for many surgical indications in this age group. While half of all glioblastoma patients are 65 years old or older, frailty has not been examined in relation to surgery for glioblastoma. Methods We performed a retrospective study of patients age 65 years and older with pathologically confirmed glioblastoma at Columbia Presbyterian Hospital from 2000 to 2012; 319 patients were identified, 243 of whom underwent craniotomy for lobar lesions. Frailty was quantified using the Canadian Study of Health and Aging Modified Frailty Index. Postoperative complications were classified according the Glioma Outcomes Project system. Systemic, regional, neurologic, and overall complications were examined in relation to age, Karnofsky performance status, frailty, comorbid disease burden, cardiovascular risk, and tumor sidedness. Results Frailer patients were less likely to undergo surgical resection (P = 0.0002; odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05-0.40) as opposed to biopsy, had longer hospital stays (log-rank test for trend, P = 0.0061), an increased overall risk of complications (P = 0.0123; OR, 1.40; 95% CI, 1.08-1.83), and decreased overall survival (Log rank test for trend, P = 0.0028). Conclusions Frailer patients with glioblastoma receive less aggressive intervention, have longer hospital stays, and experience more complications. Frailty may be an underused metric for the preoperative risk assessment of geriatric glioblastoma patients.

Original languageEnglish (US)
Pages (from-to)362-367
Number of pages6
JournalWorld neurosurgery
Volume89
DOIs
StatePublished - May 1 2016

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Glioblastoma
Geriatrics
Morbidity
Length of Stay
Odds Ratio
Confidence Intervals
Karnofsky Performance Status
Craniotomy
Glioma
Nervous System
Health Status
Cardiovascular Diseases
Retrospective Studies
Age Groups
Biopsy
Survival
Health
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Cloney, M., D'Amico, R., Lebovic, J., Nazarian, M., Zacharia, B., Sisti, M. B., ... Sonabend, A. M. (2016). Frailty in Geriatric Glioblastoma Patients: A Predictor of Operative Morbidity and Outcome. World neurosurgery, 89, 362-367. https://doi.org/10.1016/j.wneu.2015.12.096
Cloney, Michael ; D'Amico, Randy ; Lebovic, Jordan ; Nazarian, Matthew ; Zacharia, Brad ; Sisti, Michael B. ; Bruce, Jeffrey N. ; McKhann, Guy M. ; Iwamoto, Fabio M. ; Sonabend, Adam M. / Frailty in Geriatric Glioblastoma Patients : A Predictor of Operative Morbidity and Outcome. In: World neurosurgery. 2016 ; Vol. 89. pp. 362-367.
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abstract = "Background Frailty is an emerging means of assessing overall health status and guiding management for geriatric patients. Frailty is associated with outcomes for many surgical indications in this age group. While half of all glioblastoma patients are 65 years old or older, frailty has not been examined in relation to surgery for glioblastoma. Methods We performed a retrospective study of patients age 65 years and older with pathologically confirmed glioblastoma at Columbia Presbyterian Hospital from 2000 to 2012; 319 patients were identified, 243 of whom underwent craniotomy for lobar lesions. Frailty was quantified using the Canadian Study of Health and Aging Modified Frailty Index. Postoperative complications were classified according the Glioma Outcomes Project system. Systemic, regional, neurologic, and overall complications were examined in relation to age, Karnofsky performance status, frailty, comorbid disease burden, cardiovascular risk, and tumor sidedness. Results Frailer patients were less likely to undergo surgical resection (P = 0.0002; odds ratio [OR], 0.15; 95{\%} confidence interval [CI], 0.05-0.40) as opposed to biopsy, had longer hospital stays (log-rank test for trend, P = 0.0061), an increased overall risk of complications (P = 0.0123; OR, 1.40; 95{\%} CI, 1.08-1.83), and decreased overall survival (Log rank test for trend, P = 0.0028). Conclusions Frailer patients with glioblastoma receive less aggressive intervention, have longer hospital stays, and experience more complications. Frailty may be an underused metric for the preoperative risk assessment of geriatric glioblastoma patients.",
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Cloney, M, D'Amico, R, Lebovic, J, Nazarian, M, Zacharia, B, Sisti, MB, Bruce, JN, McKhann, GM, Iwamoto, FM & Sonabend, AM 2016, 'Frailty in Geriatric Glioblastoma Patients: A Predictor of Operative Morbidity and Outcome', World neurosurgery, vol. 89, pp. 362-367. https://doi.org/10.1016/j.wneu.2015.12.096

Frailty in Geriatric Glioblastoma Patients : A Predictor of Operative Morbidity and Outcome. / Cloney, Michael; D'Amico, Randy; Lebovic, Jordan; Nazarian, Matthew; Zacharia, Brad; Sisti, Michael B.; Bruce, Jeffrey N.; McKhann, Guy M.; Iwamoto, Fabio M.; Sonabend, Adam M.

In: World neurosurgery, Vol. 89, 01.05.2016, p. 362-367.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Frailty in Geriatric Glioblastoma Patients

T2 - A Predictor of Operative Morbidity and Outcome

AU - Cloney, Michael

AU - D'Amico, Randy

AU - Lebovic, Jordan

AU - Nazarian, Matthew

AU - Zacharia, Brad

AU - Sisti, Michael B.

AU - Bruce, Jeffrey N.

AU - McKhann, Guy M.

AU - Iwamoto, Fabio M.

AU - Sonabend, Adam M.

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background Frailty is an emerging means of assessing overall health status and guiding management for geriatric patients. Frailty is associated with outcomes for many surgical indications in this age group. While half of all glioblastoma patients are 65 years old or older, frailty has not been examined in relation to surgery for glioblastoma. Methods We performed a retrospective study of patients age 65 years and older with pathologically confirmed glioblastoma at Columbia Presbyterian Hospital from 2000 to 2012; 319 patients were identified, 243 of whom underwent craniotomy for lobar lesions. Frailty was quantified using the Canadian Study of Health and Aging Modified Frailty Index. Postoperative complications were classified according the Glioma Outcomes Project system. Systemic, regional, neurologic, and overall complications were examined in relation to age, Karnofsky performance status, frailty, comorbid disease burden, cardiovascular risk, and tumor sidedness. Results Frailer patients were less likely to undergo surgical resection (P = 0.0002; odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05-0.40) as opposed to biopsy, had longer hospital stays (log-rank test for trend, P = 0.0061), an increased overall risk of complications (P = 0.0123; OR, 1.40; 95% CI, 1.08-1.83), and decreased overall survival (Log rank test for trend, P = 0.0028). Conclusions Frailer patients with glioblastoma receive less aggressive intervention, have longer hospital stays, and experience more complications. Frailty may be an underused metric for the preoperative risk assessment of geriatric glioblastoma patients.

AB - Background Frailty is an emerging means of assessing overall health status and guiding management for geriatric patients. Frailty is associated with outcomes for many surgical indications in this age group. While half of all glioblastoma patients are 65 years old or older, frailty has not been examined in relation to surgery for glioblastoma. Methods We performed a retrospective study of patients age 65 years and older with pathologically confirmed glioblastoma at Columbia Presbyterian Hospital from 2000 to 2012; 319 patients were identified, 243 of whom underwent craniotomy for lobar lesions. Frailty was quantified using the Canadian Study of Health and Aging Modified Frailty Index. Postoperative complications were classified according the Glioma Outcomes Project system. Systemic, regional, neurologic, and overall complications were examined in relation to age, Karnofsky performance status, frailty, comorbid disease burden, cardiovascular risk, and tumor sidedness. Results Frailer patients were less likely to undergo surgical resection (P = 0.0002; odds ratio [OR], 0.15; 95% confidence interval [CI], 0.05-0.40) as opposed to biopsy, had longer hospital stays (log-rank test for trend, P = 0.0061), an increased overall risk of complications (P = 0.0123; OR, 1.40; 95% CI, 1.08-1.83), and decreased overall survival (Log rank test for trend, P = 0.0028). Conclusions Frailer patients with glioblastoma receive less aggressive intervention, have longer hospital stays, and experience more complications. Frailty may be an underused metric for the preoperative risk assessment of geriatric glioblastoma patients.

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