Predictors of severe complications in intracranial meningioma surgery: a population-based multicenter study

Objective To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events. Methods A retrospective review was conducted in a Scandinavian population-based cohort of 979 adult operations for intracranial meningioma performed at 3 neurosurgical centers with population-based referral between January 1, 2007, and June 30, 2013. Possible predictors of severe complications were identified and analyzed in univariable analyses. Variables with a P value < 0.10 were included in a multivariable model. Results Severe complications were observed in 68 (7%) operations. Univariable analyses identified patient age >70 years (P < 0.001), male sex (P = 0.03), Charlson Comorbidity Index >1 (P = 0.02), Simpson grade >3 (P = 0.03), Karnofsky performance scale score <70 (P < 0.001), and duration of surgery >4 hours (P < 0.001) as significant predictors of severe complications. Age >70 (odds ratio = 2.5, P < 0.01), duration of surgery >4 hours (odds ratio = 3.2, P < 0.001), and Karnofsky performance scale score <70 (odds ratio = 2.5, P < 0.01) were independent predictors of severe complications in the multivariable regression analysis. Conclusions Severe complications after meningioma resection are more encountered often in elderly patients (>70 years old), dependent patients (Karnofsky performance scale score <70), and patients who underwent longer lasting surgery (>4 hours). Patient selection, including careful consideration of the individual risk-benefit ratio, is important in improving the safety of intracranial meningioma resection.