• Michael Cloney, Randy D'Amico, Jordan Lebovic, Matthew Nazarian, Brad E Zacharia, Michael B Sisti, Jeffrey N Bruce, Guy M McKhann, Fabio M Iwamoto, and Adam M Sonabend.
• Gabriele Bartoli Brain Tumor Research Laboratory, Columbia University College of Physicians and Surgeons, New York, NY, USA; Columbia University Mailman School of Public Health, New York, NY, USA.
• World Neurosurg. 2016 May 1; 89: 362-7.

BackgroundFrailty 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.MethodsWe 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.ResultsFrailer 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).ConclusionsFrailer 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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