To Örebro University

Meningioma surgery is often considered, even at a high age, and is regarded an acceptable practice in patients without severe health problems even though there is much that is not yet known about the perioperative morbidity and mortality. Since the start 1999 the Swedish brain tumor registry has collected data on a national level. It is accepted as population based and has demonstrated good coverage. In the registry perioperative parameters such as newly diagnosed epilepsy, new focal neurological deficit, thromboembolism and date of death can be found. <h4>Methods</h4> We have collected retrospective data from the registry to perform a population based study of the perioperative period. Included are patients with meningioma at age 65 and older from regions with a high enough coverage of registration and with surgery dates from 1999 to 2015. Two diagnose groups were made (grade I and grade II+III) as suggested by the Swedish National Brain Tumor Trialist Group. Excluded are patients in the registry that have not undergone surgery, where surgery (or not) cannot be determined and where data on complications is unavailable. <h4>Results</h4> 1109 patients were included (female 67,1%, male 32,9%). Median age was 72 (range 65–90) with an even gender distribution. Most patients had grade I meningioma (88,6%, female 91,0%, male 83,8%; p<0,001) with an even age distribution. 14,1% (female 15,4%, male 11,5%, NS) had WHO-PS >2, rising with age (Age>80, 28,9%, p<0,001). Perioperative mortality was 3,6% (male 4,7%, female 3,1%; NS) but clearly higher within the older age-groups (Age 65-69 1,4%; 70-74 3,3%; 75-79 4,6%; >80 7,7%; p=0,004). In the gradeII-III group mortality was significantly higher 8,7% (p<0,001) then the gradeI group and there is a statistical correlation between a WHO-PS >2 and perioperative mortality (0–2=2,8%, 3–4=7,9%; p=0,002). 28,3% (male 33,4%, female 25,8%; p=0,008) had perioperative complications (other than death), with an even age distribution. As with mortality there is a correlation with tumor grade (grI 26,8%, grII-III 40,5%; p=0,001) and there is a correlation with WHO-PS >2 (0-2 25,7%, 3-4 40,8%; p<0,001). Surgery 1999–2007 is associated with less complications (1999-2007 16,4%, 2007-2015 37,5%; p<0,001) but not with less mortality. The most common complications were hematoma and neurologic deficit (14,3% and 13,6%; NS), both evenly distributed by gender and age group. <h4>Conclusion</h4> Our data shows similar perioperative mortality with published data. The risk of perioperative death is higher with rising age and a bad performancestatus correlates with a higher risk of both perioperative death and complications. The high rate of WHO-PS >2 might be a contributing factor to the high rates of perioperative morbidity as compared with published material. This data suggests caution when operating on elderly patients, especially older than 75 and with compromised performancestatus.