Patient-specific Preoperative Predictors of Complications Following Meningioma Resection

Introduction: Surgical resection of meningiomas can cause postoperative complications such as wound complications or systemic infections, which can create significant comorbidity. While certain patient-specific factors have been studied in other surgical contexts, the role of these factors in contributing to these specific postoperative complications for meningioma resection has not been systematically assessed.

Methods: The National Surgical Quality Improvement Program (NSQIP) database from 2006-2022 was used to review cases that involved a meningioma resection up to 30-days post-procedure. Many preoperative risk factors were reported on NSQIP and examined from 2006-2022. Wound complications were recorded as superficial, deep, and/or organ space infections as well as wound disruption; systemic complications were recorded as sepsis, septic shock, urinary tract infection (UTI), and pneumonia. After initial univariate testing, multivariate adjusted analysis correcting for age, sex, race, and American Society of Anesthesia (ASA) classification was used to determine the impact of these factors on wound/systemic complications.

Results: 18,428 patients underwent surgical resection for either a supratentorial or infratentorial meningioma from 2006-2022. 425 (2.3%) had a wound complication and 196 (1.1%) had a systemic complication. Diabetes (OR=1.55, 95%CI[1.13-2.14], p=0.0070), ventilator dependence (OR=5.00, 95%CI[2.51-9.94], p=4.6E-6), history of COPD (OR=2.46, 95%CI[1.42-4.25], p=0.0013), and history of CHF (OR=3.51, 95%CI[1.66-7.42], p=0.0010) were found to be independent predictors of systemic complications. Predictors of both systemic and wound complications were obese BMI (wound: OR=1.25, 95%CI[1.03-1.52], p=0.026; systemic: OR=1.39, 95%CI[1.04-1.86], p=0.026), chronic steroid use (wound: OR=1.50, 95%CI[1.14-1.96], p=0.0039; systemic: OR=2.57, 95%CI[1.84-3.58], p=3.4E-8), and prior sepsis (wound: OR=1.73, 95%CI[1.12-2.66], p=0.014; systemic: OR=3.56, 95%CI[2.29-5.53], p=1.8E-8). No preoperative risk factor was found to be an independent predictor of wound complications alone.

Conclusion : These results suggest that the above risk factors are associated with post-resection of meningioma complications. Limitations include only a 30-day postoperative follow-up, selection bias, and sampling bias. Future prospective studies are required to validate these results.