Poor outcome of octogenarians admitted to ICU due to periprosthetic joint infections: a retrospective cohort study

Abstract Background Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. Methods All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. Results A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p < 0.001). In multivariate analysis, RRT (odds ratio (OR) 15.4, CI 1.69–140.85; p = 0.015), invasive ventilation (OR 9.6, CI 1.28–71.9; p = 0.028) and CCI (OR 1.5, CI 1.004–2.12; p = 0.048) were independent risk factors for mortality. Conclusion Very elderly patients with PJI who needs to be admitted to the ICU are at risk to suffer from a poor outcome. Several risk factors including a chronic infection, high SAPS II Score, high CCI, invasive ventilation and RRT might be associated with a poor outcome.

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Prognosis of Very Elderly Patients After Intensive Care

10.21203/rs.3.rs-459749/v1 ◽

2021 ◽

Author(s):

Philippe Michel ◽

Fouad FADEL ◽

Gaëtan Plantefève ◽

Stephan Ehrmann ◽

bruno Gelée

Keyword(s):

Intensive Care ◽

Elderly Patients ◽

Telephone Interview ◽

Epidemiological Data ◽

Acute Pulmonary Oedema ◽

Age Group ◽

Very Elderly ◽

Exclusion Criteria ◽

Saps Ii ◽

Saps Ii Score

Abstract Background: Very elderly patients (aged over 85 years) are increasingly treated in intensive care units (ICU) despite the reluctance of doctors to admit these patients considered fragile. Only a few studies in this age group have described the relevance of treatment of these patients in the intensive care unit. Methods: he inclusion criterion for this study was patients aged 85 years or over on admission. The exclusion criteria were high dependence before admission or an inability to answer the telephone. Epidemiological data, antecedents, lifestyle, autonomy (ADL score of six items) were recorded on admission to the ICU and by telephone interview at six months. Results: Eight French ICU included 239 patients aged over 85 years. The most common diagnoses were non-cradiogenic lung disease (36%), severe sepsis / septic shock (29%) and acute pulmonary oedema (28%). 23% of patients were dependent on admission. 71% of patients were still living when discharged from the ICU and 52% were still living at 6 months. Among the non-dependent patients before hospitalisation, 17% became dependent. The only prognostic criteria found were the SAPS II score on admission and the place of residence before admission (nursing home or ”with family” had a poor prognosis). Conclusions: Although the prognosis of these very elderly patients was good after hospitalisation in the ICU, it should be noted that the population was highly selected with few comorbidities or dependence. No triage criteria could be proposed. ClinicalTrials.gov Identiﬁer: NCT02849756

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Stroke about very elderly patients in West African Country (Niger): Prognosis risk factors

10.30574/ijsra.2021.2.1.0001 ◽

2021 ◽

Vol 2 (1) ◽

pp. 006-011

Author(s):

Andia Abdoulkader ◽

Garba Abdoul Aziz ◽

Idrissa Hama ◽

Larent Youmbi ◽

Brah Souleymane

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Multidisciplinary Approach ◽

Hemorrhagic Stroke ◽

African Country ◽

Neurovascular Unit ◽

West African ◽

Medical Emergency ◽

Very Elderly ◽

Nihss Score

Background: Chronic diseases such as stroke most frequently occur on old people while literature on prognosis risk factors on elderly is rare particularly Sub-Sahara Africa. The aim of the study is to determine prognosis risk factors of stroke on elderly patients. Method: It was a prospective cohort study carried out during 6 months that included elderly patients over 70 years old admitted in two tertiary medical emergency departments. Results: 56 patients with mean age 75.2 ± 5.17 showed moderate NIHSS score (59%) without gender predominance. 75% of patients with a severe score were in the 70-79 years old group. Functional dependency (93%) increased with the NIHSS score severity and 50% of patients with a moderate NIHSS score showed normal nutritional status unlike patients with a severe NIHSS score and depression for most of the cases. Mortality was frequent for patients with hemorrhagic stroke with swallowing disorder and a severe NIHSS score. Conclusion: Stroke on very elderly patients appears moderate with mortality chances increasing according to the severity of the NIHSS score, swallowing disorders that require a multidisciplinary approach in a neurovascular unit.

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Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species

Journal of Clinical Medicine ◽

10.3390/jcm9051431 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1431 ◽

Cited By ~ 1

Author(s):

Hye Seong ◽

Jung Ho Kim ◽

Jun Hyoung Kim ◽

Woon Ji Lee ◽

Jin Young Ahn ◽

...

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Antimicrobial Susceptibility ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Intrinsic Resistance ◽

Albumin Ratio ◽

Saps Ii ◽

Saps Ii Score ◽

Susceptibility Patterns

Elizabethkingia species (spp.), which can colonize hospital environments, are emerging nosocomial pathogens presenting high mortality. Due to their intrinsic resistance to a broad range of antibiotics, optimal antibiotic dosage has yet to be determined against infections caused by Elizabethkingia spp. This study aimed to investigate the risk factors for the mortality of infections caused by Elizabethkingia spp. and assess the clinical implications of their antimicrobial susceptibility patterns. Data from 210 patients affected by Elizabethkingia-induced pneumonia and bacteremia between 1 November 2005 and 31 May 2016, were analyzed. Further antimicrobial susceptibility tests for moxifloxacin, rifampin, and vancomycin using Elizabethkingia isolates were performed to compensate for the Elizabethkingia spp. susceptibility panel in patients affected after 2013. The mean age of the patients was 66.5 ± 18 years and the 28-day mortality rate was 25.2% (53/210). In the univariate analysis, history of prior stay in an intensive care unit, central venous catheter use, presented thrombocytopenia, immunocompetent status, a high simplified acute physiology score II (SAPS II score), a high C-reactive protein (CRP)/albumin ratio on the day of isolation and seven days later, and a high minimum inhibitory concentration (MIC) value of rifampin were significantly associated with a higher mortality rate. In the multivariate logistic regression analysis, the MIC values of rifampin (odds ratio (OR): 1.045; 95% confidence interval (CI): 1.006–1.085; p = 0.023), SAPS II score (OR: 1.053; 95% CI: 1.022–1.084; p = 0.001), and initial CRP/albumin ratio (OR: 1.030; 95% CI: 1.009–1.051; p = 0.004) were significantly associated with 28-day mortality. To reduce the mortality associated with Elizabethkingia infections, prediction of the clinical course using initial CRP/albumin ratio and SAPS II and early intervention are essential. Rifampin is a promising candidate as the drug of choice in treating Elizabethkingia infections.

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Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study

Frontline Gastroenterology ◽

10.1136/flgastro-2018-100994 ◽

2018 ◽

Vol 9 (4) ◽

pp. 256-261 ◽

Cited By ~ 1

Author(s):

Ayodele Sasegbon ◽

Laura O’Shea ◽

Shaheen Hamdy

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Elderly Person ◽

Oropharyngeal Dysphagia ◽

The Elderly ◽

Common Source ◽

Increased Risk ◽

The Mean ◽

The Relationship ◽

New Onset

IntroductionElderly people are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are multifactorial. Our aim was to identify if sepsis is associated with OPD in the elderly during hospitalisation in the absence of known other risk factors for OPD.MethodsA hospital electronic database was searched for elderly patients (≥65 years) referred for assessment for suspected dysphagia between March 2013 and 2014. Exclusion criteria were age <65 years, pre-existing OPD or acute OPD secondary to acute intracranial event, space-occupying lesion or trauma. Data were collected on factors including age, sex, comorbidities, existing OPD, sepsis, microbiology, recovery of OPD and medication. Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.ResultsA total of 301 of 1761 screened patients referred for dysphagia assessment met the inclusion criteria. The prevalence of sepsis and subsequent OPD was 16% (51/301). The mean age was 83 years (median 81 years). The most common comorbidity was dementia (31%). The majority (84%) failed to recover swallowing during their hospital stay, 12% had complications of aspiration and 35% died. The most common source of sepsis was from the chest (55%). Other factors contributing to the risk for dysphagia included delirium (22%) and neuroactive medication (41%). However, 10% of patients had sepsis and subsequent OPD without other identified risk factors.ConclusionThe prevalence of sepsis and subsequent dysphagia is significant and should be taken into account in any elderly person in hospital with new-onset OPD without other predisposing risk factors.

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Study on the correlation between Left Ventricular Hypertrophy and Coronary Artery disease in the very elderly patients with hypertension

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.5.4135 ◽

2021 ◽

Vol 37 (5) ◽

Author(s):

Jian-hua Sun ◽

Xiao-kun Liu ◽

Qi Zhang ◽

Qing-hua Zhang

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Left Ventricular Hypertrophy ◽

Elderly Patients ◽

Coronary Stenosis ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Very Elderly ◽

Artery Disease

Objective: To investigate the relationship between left ventricular hypertrophy (LVH) and coronary artery disease in the very elderly (over 80 years old) patients with hypertension. Methods: One hundred twenty cases of very elderly patients with hypertension admitted to our hospital from March 2018 to December 2020 were selected and divided into two groups: the LVH group and the non-LVH group, all of whom were older aged over 80 years, including 62 patients in the LVH group and 58 patients in the non-LVH group. All patients underwent cardiac color Doppler ultrasound examination, 24-hour dynamic ECG examination, and coronary angiography or coronary CTA examination. The clinical data of the two groups were analyzed statistically. Results: There were significant differences in the number of diseased vessels, degree of coronary stenosis and vascular calcification between the two groups (P<0.05). Moreover, the results of risk factors for the degree of coronary artery disease in the two groups showed that the history of diabetes, 2hPG and LVH were independent risk factors for the three-vessel disease, while the history of LVH, FPG and alcohol intake were independent risk factors for diffuse lesions, but there was no statistical difference in the correlation between them and the degree of coronary stenosis. Conclusion: LVH is an independent risk factor for coronary artery stenosis and calcification in the very elderly patients with hypertension, but there is no statistical difference in the correlation between LVH and the degree of coronary stenosis. doi: https://doi.org/10.12669/pjms.37.5.4135 How to cite this:Sun JH, Liu XK, Zhang Q, Zhang QH. Study on the correlation between Left Ventricular Hypertrophy and Coronary Artery disease in the very elderly patients with hypertension. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.4135 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Diffuse Large B Cell Lymphoma in Very Elderly Patients

Blood ◽

10.1182/blood.v124.21.5453.5453 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5453-5453

Author(s):

Ajay Dhakal ◽

Pouyan Gohari ◽

Charalampos Floudas ◽

Sanjay Neupane ◽

Abhinav B Chandra

Keyword(s):

Elderly Patients ◽

Chemotherapy Regimen ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Very Elderly ◽

Large B Cell Lymphoma ◽

Co Morbidity ◽

The Mean ◽

Ecog Ps ◽

Dose Delay

Abstract Background: Incidence of Diffuse Large B-Cell Lymphoma (DLBCL), one of the most common lymphoid malignancies worldwide, increases with age. With improving life expectancy, its incidence among the elderly population is predicted to rise further. Elderly patients pose unique challenges- multiple co-morbidities, variable life expectancy, poor social support systems, and increased risk of therapy-related toxicity. Management decisions in geriatric patients are usually based on data obtained in younger patients. R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone) is the standard chemotherapy for younger patients with DLBCL. Unfortunately, among the patients aged 80 or more, data on the use of R-CHOP and its comparison with other treatment regimens are meager. Also, new data on alternate chemotherapy regimens including R with Bendamustine (R-Benda) and R with low dose CHOP (R-miniCHOP) are emerging. Thus, there is a need for development and validation of treatment strategies for DLBCL in this patient population. Objective of this study is to provide a descriptive data including co-morbidity profile, chemotherapy regimen offered, tolerance of chemotherapy, and outcome of the treatment among the DLBCL patients aged 80 or more. Methodology: A retrospective chart review of 33 DLBCL patients (N) aged 80 or more treated in the last 4 years in a tertiary community hospital. Results: Table 1 Age Charlson Co-morbidity Index (CCI) Serum Lactate Dehydrogenase Serum Albumin Serum Beta2 Microglobulin Median Ki67 Valid N 33 30 23 24 9 11 Mean 83.33 2.87 611.91 2.85 6.77 0.70 Median 83.00 2.00 302 2.95 4.85 0.75 Standard Deviation 5.50 1.94 1033.15 0.78 5.79 0.19 Minimum 69 0 84 1.60 1.90 0.40 Maximum 93 9 5038 4.20 19.70 0.95 Table 2 ECOG Performance Score International Prognostic Index (IPI) BMI Hemoglobin Platelets WBC ANC Valid N 25 16 8 31 30 31 28 Mean 2.16 2.56 25.70 11.58 240.73 8.73 5971 Median 2.00 3.00 25.95 11.60 201 8.20 5400 Standard Deviation 1.17 1.03 2.910 1.94 129.64 3.47 2935 Minimum 0 1 20.98 8.20 62 3.60 1400 Maximum 4 4 29.40 15.10 716 16.10 12800 Table 3 Valid N Categories Percentage Sex 33 Male Female 54.5 45.5 Prior Malignancy 33 No Yes 81.8 18.2 Ann Arbor Staging 22 1 2 3 4 22.7 18.2 22.7 36.4 B symptoms 29 No Yes 62.1 37.9 Node Status 33 Nodal Extranodal Nodal and Extranodal 6.1 42.4 51.5 Chemotherapy offered 28 No Yes 17.9 82.1 Intent of Therapy 20 Curative Palliative 85 15 Chemotherapy regimen 22 R-miniCHOP R R-Bendamustine R-CHOP RCVP RCNOP 22.7 9 18.18 36.36 9 4.54 Adverse effect of Chemotherapy 16 No Yes 18.75 81.25 Hospital admission during Chemotherapy 19 No Yes 47.36 52.63 Growth factors required during Chemotherapy 20 No Yes 25 75 Dose delay 17 No Yes 70.58 29.42 Dose modification 17 No Yes 64.70 35.29 Chemotherapy stopped prior to completion 18 No Yes 66.67 33.33 Radiation therapy 19 No Yes 52.63 47.36 Result of chemotherapy 15 Complete Response (CR) Partial Response (PR)Progression 40 40 20 Relapse 7 No Yes 57.14 42.85 Death 10 No Yes 20 80 ANOVA was used for data analysis. A statistically significant difference in mean CCI between those who completed planned chemotherapy course (2.00) and those who did not (4.75) was observed (p= 0.017). Similarly, difference in the mean CCI among those achieving CR (2.00), PR (2.17) and Progression (7.00) was statistically significant (p= 0.005). There were significant differences in the mean pre-chemotherapy ECOG PS between those who completed planned chemotherapy course (1.27) vs. those who did not (2.75), (p= 0. 001) and those achieving CR (1.60), PR (1.00) and progression (3.00), (p=0.012). No significant association was found between CCI or pre-chemotherapy ECOG PS with various factors like type of chemotherapy offered, incidence of adverse effects, and dose delay/modification. Conclusion: Very elderly patients (≥80 years) with DLBCL having good ECOG PS or lower CCI are more likely to complete planned chemotherapy course and achieve remission. CCI might be a good marker for evaluation of co-morbidities in very elderly patients and could serve as a predictive tool for patient outcomes. We intend to analyze data of DLBCL patients aged 65 – 79 years and perform comparative study with existing cohort. Disclosures No relevant conflicts of interest to declare.

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Analysis of Pepsin Concentration and Influencing Factors in Saliva of Elderly Nasal Feeding Patients

BioMed Research International ◽

10.1155/2021/4721812 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Yu Ding ◽

Huiru Hou ◽

Miao Liu ◽

Xiaoyuan Wang ◽

Yue Xu ◽

...

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Influencing Factors ◽

The Elderly ◽

Cross Sectional Study ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional ◽

Feeding Methods ◽

The Mean ◽

Esophageal Sphincter

Background. Elderly patients receiving nasal feeding have weaker physiological function, and placement of a nasogastric tube weakens the natural barrier of the cardia-esophageal sphincter; therefore, the risk of gastroesophageal reflux (GER) is higher. Many studies have shown that pepsin is extremely sensitive in predicting GERD, so this study intends to investigate the level of pepsin in saliva of elderly patients with nasal feeding and analyze its influencing factors. Methods. This was a cross-sectional study. Patients admitted to the Chinese PLA General Hospital from April 2018 to October 2018 who received nasal feeding were included. One ml of saliva was collected from each patient in while sitting during fasting in the morning and 1 hour after lunch for 3 consecutive days. Pepsin was quantified by enzyme-linked immunosorbent assay (ELISA). The patients were predivided into two groups (≥7.75μg/ml or <7.75μg/ml) based on the median pepsin. Baseline and clinical factors were compared. Results. The mean age of the patients was 91.09 ± 4.91 years. There were statistical differences in diabetes and feeding methods between the two groups. There was a positive correlation between the morning and postprandial pepsin levels ( r = 0.442 , P < 0.001 ), and has no statistical difference ( P = 0.175 ). Multivariate analysis showed that the risk factors for higher pepsin levels were diabetes (odds ratio (OR): 2.67; 95% CI: 1.225-5.819, P = 0.013 ) and nasal feeding methods (OR: 2.475; 95% CI: 1.183-5.180, P=0.016). Conclusions. For patients undergoing nasal feeding who are older than 80 years, the fasting and 1-hour postprandial pepsin concentration were consistent. Diabetes and feeding methods are risk factors for high pepsin levels. For the elderly over 80 years old, age has no influence on pepsin concentration.

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Diagnostic accuracy of neutrophil counts in histopathological tissue analysis in periprosthetic joint infection using the ICM, IDSA, and EBJIS criteria

Bone and Joint Research ◽

10.1302/2046-3758.108.bjr-2021-0058.r1 ◽

2021 ◽

Vol 10 (8) ◽

pp. 536-547

Author(s):

Irene K. Sigmund ◽

Martin A. McNally ◽

Markus Luger ◽

Christoph Böhler ◽

Reinhard Windhager ◽

...

Keyword(s):

Operating Characteristic ◽

Joint Infection ◽

Test Methods ◽

Polymorphonuclear Neutrophils ◽

Histopathological Analysis ◽

Roc Curve Analysis ◽

International Consensus ◽

Joint Infections ◽

Test Thresholds ◽

The Mean

Aims Histology is an established tool in diagnosing periprosthetic joint infections (PJIs). Different thresholds, using various infection definitions and histopathological criteria, have been described. This study determined the performance of different thresholds of polymorphonuclear neutrophils (≥ 5 PMN/HPF, ≥ 10 PMN/HPF, ≥ 23 PMN/10 HPF) , when using the European Bone and Joint Infection Society (EBJIS), Infectious Diseases Society of America (IDSA), and the International Consensus Meeting (ICM) 2018 criteria for PJI. Methods A total of 119 patients undergoing revision total hip (rTHA) or knee arthroplasty (rTKA) were included. Permanent histology sections of periprosthetic tissue were evaluated under high power (400× magnification) and neutrophils were counted per HPF. The mean neutrophil count in ten HPFs was calculated (PMN/HPF). Based on receiver operating characteristic (ROC) curve analysis and the z-test, thresholds were compared. Results Using the EBJIS criteria, a cut-off of ≥ five PMN/HPF showed a sensitivity of 93% (95% confidence interval (CI) 81 to 98) and specificity of 84% (95% CI 74 to 91). The optimal threshold when applying the IDSA and ICM criteria was ≥ ten PMN/HPF with sensitivities of 94% (95% CI 79 to 99) and 90% (95% CI 76 to 97), and specificities of 86% (95% CI 77 to 92) and 92% (95% CI 84 to 97), respectively. In rTKA, a better performance of histopathological analysis was observed in comparison with rTHA when using the IDSA criteria (p < 0.001). Conclusion With high accuracy, histopathological analysis can be supported as a confirmatory criterion in diagnosing periprosthetic joint infections. A threshold of ≥ five PMN/HPF can be recommended to distinguish between septic and aseptic loosening, with an increased possibility of detecting more infections caused by low-virulence organisms. However, neutrophil counts between one and five should be considered suggestive of infection and interpreted carefully in conjunction with other diagnostic test methods. Cite this article: Bone Joint Res 2021;10(8):536–547.

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Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma

Neurosurgical FOCUS ◽

10.3171/2018.1.focus17730 ◽

2018 ◽

Vol 44 (4) ◽

pp. E14 ◽

Cited By ~ 6

Author(s):

Manish Kolakshyapati ◽

Fusao Ikawa ◽

Masaru Abiko ◽

Takafumi Mitsuhara ◽

Yasuyuki Kinoshita ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Prognostic Factors ◽

Elderly Patients ◽

Skull Base ◽

Karnofsky Performance Scale ◽

Preoperative Risk ◽

Skull Base Meningioma ◽

The Mean ◽

Performance Scale

OBJECTIVEElderly patients are particularly at risk for severe morbidity following surgery. Among the various risk factors, age and skull base location of meningioma are known to be poor prognostic factors in meningioma surgery. The authors conducted this study to analyze significant preoperative risk factors in elderly patients with skull base meningioma.METHODSA total of 265 elderly patients (≥ 65 years old) with meningioma were surgically treated at the authors’ institute and affiliated hospitals between 2000 and 2016, and these cases were reviewed. Among them, 57 patients with skull base meningioma were evaluated. Among the various risk factors, the authors analyzed age, sex, Karnofsky Performance Scale (KPS) score, American Society of Anesthesiologists score, and tumor size, location, and pathology. Body mass index (BMI) and serum albumin were investigated as the frailty factors. The authors also reviewed 11 surgical studies of elderly patients ≥ 60 years old with meningioma.RESULTSThe mean age was 72.4 ± 5.7 years, and 42 patients were female (73.6%). The mean size of meningioma was 36.6 ± 14.8 mm at the maximum diameter, and the mean follow-up period was 31.1 ± 31.5 months. (The continuous variables are expressed as the mean ± SD.) Histopathological investigation revealed a higher incidence (71.9%) of WHO Grade I. The rates of deterioration after surgery, at 3 months, and at 1 year were 33.3%, 37.3%, and 39.1%, respectively. Univariate analysis revealed location, preoperative KPS score, BMI level 2, and serum albumin level (p = 0.010, 0.017, 0.0012, and 0.0019, respectively) to be poor prognostic factors. Multivariate analysis revealed that location (p = 0.038) and BMI (p = 0.035) were risk factors for KPS score deterioration immediately after surgery. According to the 11 papers reviewed, the median rate (25th–75th percentile) of skull base–related location was 43.5% (39.6–47.75); for asymptomatic status the mean was 24%; and for mortality at 3 months and 1 year the medians were 6.3% (0.7–7.1) and 8% (4.8–9.4), respectively.CONCLUSIONCareful preoperative assessment based on the frailty concept was essential for better outcome in elderly patients with skull base meningioma. The BMI is appropriate as a quantitative factor for measure of frailty, particularly in elderly individuals with skull base meningioma. Further prospective randomized controlled trials are necessary to validate frailty as a preoperative risk factor. Not only patient selection but also surgical timing was an important factor.

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