Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas

Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas Peter Zaki, Sanjeev Herr, Lana Al Doori, Abigail Murtha, Davin Evanson, and 11 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4432842/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: High-grade gliomas (HGGs) are aggressive brain tumors associated with significant morbidity. This study aims to assess the utility of the 5-factor Modified Frailty Index (mFI-5) in predicting postoperative outcomes and overall survival in patients undergoing surgical resection for HGGs. Methods: We conducted a retrospective analysis of 196 patients treated surgically for GBM at our institution from January 2016 to January 2023. Patients were stratified into three groups based on their preoperative mFI-5 scores: prefrail ( 2). Primary outcomes included 30-day, 90-day, and 1-year survival and progression-free survival. Secondary outcomes focused on hospital length of stay (LOS), 30-day readmission rates, and discharge status. Univariate and multivariate analyses evaluated the impact of frailty on these outcomes. Results: Frailty was significantly associated with adverse outcomes. The median progression free survival was 9.2 months in the prefrail, 6.9 months in the frail and 3.5 months in severely frail patients (p = 0.01). Furthermore, the 90-day OS was 89%, 91% and 75% for the prefrail, frail and severely frail group respectively (p = 0.03). However, there was no statistically significant difference in 12-month OS (64%, 70%, 58%; p = 0.72). The median survival for the cohort was 17.9 months in the prefrail, 15.4 months in the frail and 15.3 in the severely frail (p = 0.02). Severely frail patients demonstrated lower rates of symptomatic resolution (66%,53%, 33% respectively; p = 0.005), increased non-home discharge rates (24%, 55.9%, 75%, respectively; P 2 upon discharge (5%, 26%, and 66% respectively; P < 0.001). Conclusion: The mFI-5 is a valuable tool for preoperative risk stratification in patients with GBM, predicting short-term survival and postoperative outcomes. Integrating frailty assessments into preoperative evaluations can aid in tailoring surgical and adjuvant therapies, potentially improving patient outcomes and optimizing resource allocation. This study supports the adoption of frailty assessments in neuro-oncological practice to enhance personalized care strategies for patients with HGGs. high-grade glioma glioblastoma frailty Modified Frailty Index surgical outcomes Figures Figure 1 Figure 2 Introduction High grade gliomas (HGGs), currently termed astrocytoma IDH-mutant grade 4, are rare, aggressive primary brain tumors that are associated with poor outcomes. 1 The standard treatment for HGGs remains maximal safe surgical resection followed by adjuvant external beam radiotherapy and temozolomide. 2 For patients to tolerate adjuvant chemotherapy/radiation, however, patients must first recover sufficiently from surgery with an acceptable performance status. It is therefore crucial to explore variables that may be negative prognostic indicators for patients prior to surgical resection. An emerging area of interest is the role of patient frailty in predicting postoperative outcomes 3 , 4 . Increasingly, patient frailty is being recognized as a crucial factor influencing outcomes after various surgical procedures, including those in surgical-oncology and orthopedic surgery. 5 , 6 Recently, frailty has been investigated as a predictor for outcomes of patients with HGGs treated with surgery and adjuvant therapy. 7 – 9 Research has consistently shown a correlation between frailty metrics and postoperative outcomes. 10 , 11 The predictive value of frailty and other risk factors has been specifically investigated in older adults undergoing surgical treatment for HGGs as age is an additional risk factor excluded from the mFI-5 that may impact outcomes of surgery in this population. 11 , 12 Greater frailty specifically has been identified as a predictor of greater risk of complications and decreased survival in older adults that have undergone surgery for HGGs. 12 Traditionally, multifactor indices such as the Charlson Comorbidity Index (CCI), the mFI-9, and the mFI-11 have been used to assess frailty. 13 These indices, while thorough, can be complex to calculate and often require data not always readily available in-patient records, making real-time clinical decision-making challenging. To address these limitations a streamlined, validated measure known as the 5-factor modified frailty index (mFI-5) has been developed. This index simplifies the evaluation process by assigning points based on five key variables: the need for assistance with daily living activities, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, and hypertension. Emerging studies utilizing the mFI-5 have demonstrated a clear link between higher levels of preoperative frailty and increased risks of adverse postoperative outcomes. 14 , 15 This underscores the importance of incorporating frailty assessment in preoperative planning to improve patient outcomes and for pre-operative patient counseling. 15 The purpose of this study is to evaluate whether increasing mFI-5 scores are associated with increased peri-operative morbidity and OS for patients with newly diagnosed HGGs. Methods A retrospective chart review was conducted on patients undergoing HGG surgery at our institution between 2016 and 2023. Included were patients 18 years or older with Grade IV IDH-WT astrocytoma (glioblastoma) who had at least 30 days of post-operative follow-up. Excluded were those without sufficient pre-operative clinical information for mFI-5 scores. Institutional Review Board approval and informed consent were obtained. Clinical and radiographic data included demographics, surgical details, overall survival (OS), length of stay (LOS), readmission and reoperation rates, non-home disposition (NHD), and discharge modified Rankin Scale (mRS) scores. MRI scans were reviewed for tumor size (RANO), recurrence, and peritumoral edema. Data was censored at last follow-up or death. Primary outcomes were 30-day, 90-day, 6-month, and 1-year survival and progression-free survival (PFS). Secondary outcomes included 30-day readmission, NHD, LOS, new neurologic deficits, resolution of preoperative deficits, and discharge mRS > 2. The mFI-5 score stratified patients into prefrail (mFI-5 2). Univariate comparisons used t-tests and chi-squared/Fisher’s exact tests. Cox regressions determined factors for tumor recurrence, 90-day PFS, OS, and 90-day survival. Logistic regressions predicted NHD, symptom resolution, and mRS > 2. Linear regression predicted LOS. Stepwise selection chose variables for multivariate analysis. A p-value < 0.05 was significant. Results Patient Demographics 196 patients underwent surgical resection of a HGG and are included in this analysis. In this analyzed population, the mean age at resection was 58.6 ± 13.3 with a male predominance (101/196, 56.1%). The most common symptoms at admission were confusion (50/196, 22.9%) or focal neurologic deficit (FND) (39/196, 19.9%). 22.9% of patients had more than one symptom at presentation (50/196, 22.9%) ( Table 1 ). Patients underwent intervention within 2.4 ± 2.3 days from admission, with average tumor volume being 1.8cm ± 0.6. Surgery length on average took 140 ± 34.4 minutes. Mean length of stay (LOS) was 7.4 ± 6.4 days. 38.4% of patients were discharged to either a subacute nursing facility or rehab center. 29.1% had a post-op complication of either urinary tract infection (3/196, 1.5%), pneumonia (6/196, 3.1%), or DVT (16/196, 8.2%), Pulmonary embolism (4/196, 2.0%), new neurologic deficit (28/196, 14.3%). Resolution of preoperative symptoms was 66.7% for prefrail, 52.9% frail, and 33.3% severely frail, which was statistically significant (P < 0.01). Median mRS did not change from admission to discharge. Population demographics are in Table 1 . Comparison of Baseline Demographics Amongst Frailty Groups Table 2 summarizes the basic demographics of patients with different frailty scores. 76.2% (147/193) of patients had a mFI score 0–1, classified as prefrail, 17.6% (34 /193) had a mFI score of 2, classified as frail, and 6.2% (12/193) had an mFI score of 3–5, classified as severely frail. The difference between the age of these three frailty groups (prefrail 58.1 ± 12.5, frail 59.9 ± 14.9, and severely frail 66.9 ± 13.1) was not statistically significant (p = 0.07) although there was a tendency for patients in the severely frail cohort to be older. Patients in the frail cohort tended to have increased rates of altered mental status upon initial presentation (52.9% versus 25.5%, p < 0.05). Midline shift, tumor size and peritumoral edema amount were not significantly different between groups. The prefrail and frail groups had increased rated of peritumoral edema compared to severely frail group (59.8% of prefrail, 58.8% of frail, and 16.6% of severely frail patients (p < 0.01)). A history of anticoagulation use had statistical significance with 13.6% of prefrail, 38.2% of frail, and 33.3% of severely frail (p < 0.01). The rates of gross total resection (GTR) among the prefrail, frail and severely frail were (29.9%, 38.2%, and 8.3%, respectively) while the rates of subtotal (STR) resection were (64.6%, 55.9%, 91.7%, respectively) and these rates were not statistically significant among the three frailty groups. Primary outcomes Overall Survival The 30-day survival rate was not statistically different between groups. However, the 90-day survival rates were notably improved in the pre-frail/frail cohorts compared to the severely frail patients (90 day OS: 89.1%, 91.2%, 75% of prefrail, frail, and severely frail groups, p < 0.05, Table 5 ). The median survival for the cohort was 17.9 months in the prefrail, 15.4 months in the frail and 15.3 in the severely frail (p = 0.02) ( Fig. 1 ) . Univariate and Multivariate Factors Associated with Survival Age > 75 (Univariate: HR 2.5, P < 0.001; multivariate: HR: 2.4, P = 0.03) and anticoagulation use (Univariate: HR 2.3, P < 0.001; multivariate: HR: 1.7, P = 0.03) were independent predictors of OS in the univariate and multivariate analyses. Being severely frail (Univariate: HR 2.2, P < 0.01; multivariate: HR: 1.1, P = 0.8), and having post-operative FND (Univariate: HR 1.8, P < 0.001; multivariate: HR: 1.5, P = 0.07) were only predictors in the univariate analysis (Table 3 ). The 90 Day survival rate for individuals in the severely frail cohort was significantly decreased in both univariate and multivariate analysis (HR 6.1; CPH p < 0.05 and HR 6.8; CPH p < 0.05, respectively) Supplemental Table 1 . Additionally, in the univariate analysis having FND (HR 4.7; CPH p < 0.05) and anti-coagulation use (HR 3.8; CPH p < 0.05) were associated with a decreased likelihood of 90 Day survival. In the multivariate analysis pre-op tumor size was associated with decreased likelihood of 90 Day survival (HR 0.6; CPH p 75 (Univariate: HR 3.9, P < 0.001; multivariate: HR: 3.5, P = 0.02) continued to be independent predictors of survival at 6 months Supplemental Table 2. At 12 months, only age remained an independent predictor of survival (Univariate: HR 2.5, P = 0.01; multivariate: HR: 3.6, P = 0.004) Supplemental Table 3. Progression Free Survival The median PFS was 9.2 months in the prefrail group, 6.9 months in the frail group and 3.5 months in the severely frail group ( Fig. 2 ) . Severe frailty (Univariate: HR 2.4, P = 0.005; multivariate: HR: 2.0, P = 0.04), age > 75 (Univariate: HR 2.1, P = 0.005; multivariate: HR: 1.5, P = 0.04), and post-operative FND (Univariate: HR 1.5, P = 0.008; multivariate: HR: 2.1, P = 0.02) were the only factors that were independent predictors of PFS in the univariate and multivariate analyses ( Table 4 , Fig. 2 ) supporting the fact that severely frail patients, older than 75 with post-operative FND are less likely to survive without progression of their disease. Secondary outcomes Disposition and Length of Stay There was a notable increase in the likelihood of NHD status in the frail (19/34, 55.9%) and severely frail (9/12, 75%) cohorts compared to the prefrail cohort (36/147, 24.5%) (CPH p < 0.01) Table 5 . The overall non-home discharge for the entire cohort was 32.7% (64/196). (CPH p < 0.01). Factors associated with NHD status on univariate analysis and multivariate analysis were frail (Odds Ratio [OR] 3.7; CPH p < 0.01 and OR 3.8; CPH p < 0.01, respectively), severely frail (OR 8.3; CPH p < 0.01 and OR 6.9; CPH p 75 (OR 11.5; CPH p < 0.01, and OR 9.2; CPH p < 0.01, respectively). Anticoagulant use was only associated on univariate analysis (OR 3.4; CPH p < 0.01). The only factor associated with home discharge was gender on univariate (OR 0.49 CPH p < 0.05) and multivariate analysis (OR 0.48; CPH p < 0.05) Supplemental Table 4 . The median length of stay was 4.6 ± 4.4 for prefrail, 7.5 ± 7.6 for frail, and 5 ± 3.1 severely frail (P < 0.05) Table 5 . Factors associated with a longer length of stay on univariate analysis and multivariate analysis were frail (Parameter Estimate (PE) 2.82; CPH p < 0.01 and PE 2.74; CPH regression P 75 (PE 3.07; CPH p < 0.05 and PE 3.74; CPH p 2 status at discharge in the frail (9/34, 26.5%) and severely frail (8/12, 66.7%) cohorts compared to the prefrail cohort (8/147, 5.4%) (CPH p 2 for the entire cohort was 12.8% (25/196). Factors associated with mRS > 2 at discharge on univariate analysis and multivariate analysis were frail (OR 6.25; CPH p < 0.01 and OR 13.53; CPH p < 0.01, respectively) and severely frail (OR 34.75; CPH p < 0.01 and OR 87.5; CPH p < 0.01, respectively). Symptomatic Resolution The overall resolution of pre-op symptoms for the entire cohort was 61.22% (120/196). The resolution rate was 66.67% (98/147), 52.94% (18/34), and 33.33% (4/12) for the prefrail, frail, and severely frail cohorts (CPH p < 0.01), respectively Table 5 . On univariate analysis and multivariate analysis, frail (OR 0.45; CPH regression p < 0.05 and OR 0.42; CPH regression p < 0.05, respectively) and severely frail (OR 0.19, CPH p < 0.01 and OR 0.23; CPH p < 0.05, respectively) patients were less likely to demonstrate resolution of pre-op symptoms. Peritumoral edema size was only associated with an increased likelihood of pre-op symptom resolution on univariate analysis (OR 2.16; CPH p < 0.05) Supplemental Table 7. Readmission rates and time to adjuvant therapy (chemotherapy, radiation) None of the analyzed variables were independent predictors of time to adjuvant therapy with median time to adjuvant therapy (42 days, 39 days, and 34 days in the prefrail, frail and severely frail respectively) Supplemental Table 8. Furthermore, only tumor laterality was associated with 30-day readmission ( Univariate: HR 2.7, P = 0.02; multivariate: HR: 4.7, p = 0.003) while no factors were associated with 90-day readmission in our cohort Supplemental Table 9 ,10. Discussion Due to increased life expectancy of older generations and technological advancements in diagnostic methods, the incidence and prevalence of GBM are expected to increase 16 . The median age of diagnosis falls between 68–70 years 17 . The outcomes of patients undergoing resection for GBM have been previously reported within different patient populations with varied OS and PFS rates. 17 – 20 Despite improvements in the pathogenesis of HGGs, the median OS/PFS for HGGs has changed little in the past several decades. It is therefore increasingly important to identify prognostic factors that are agnostic to the underlying tumor biology and to identify a priori which patients may benefit from aggressive upfront surgery versus those who are unlikely to benefit from aggressive surgical excision 21 – 23 . Evidence from the current literature and our institutional experience underscores the varied perioperative outcomes for patients undergoing resection for GBM. This retrospective study sought to demonstrate the predictive ability of the mFI-5 score on postoperative patient outcomes following surgical resection of GBM. While there was no significant impact of frailty on median OS on multivariate analysis, our results found a significant correlation between frailty and increased mortality at 90-days. These results suggest that patients in the frail and severely frail cohorts are less likely to survive the immediate peri-operative period, but if they do, their oncologic outcomes with respect to longevity mirror those in the pre-frail cohort. Along these lines, severely frail patients were less likely to recover from their admission symptoms post-operatively, and more likely discharged to rehab or subacute nursing centers. Frail and severely frail patients were likewise less likely to have improvement in their pre-operative symptoms, shown by an increased mRS on discharge. Most intriguing, our results suggest that patients with higher frailty scores have diminished PFS after surgery. We hypothesize that frail individuals are less likely to tolerate adjuvant chemotherapy/radiation and therefore have earlier tumor recurrence. Introducing enhanced recovery pathways into the care of patients with gliomas may help overcome this and is a subject of future research. Our findings are consistent with previous literature and support the hypothesis that increasing frailty can have detrimental effects on patient postoperatively. Huq et al., investigated the effects of frailty using different frailty indicators (CCI, mFI-11 and mFI-5) and found that increased frailty was associated with increased complications rate postoperatively in brain tumor patients. 24 Sepher et al underscore the impact of frailty on postoperative outcomes in neurosurgical patients with brain tumors, emphasizing that higher frailty scores significantly correlate with increased risks of complications, mortality, readmission, and the need for reoperation. Notably, the mFI-5 and mFI-11, despite their simplicity, demonstrate a predictive strength that rivals or surpasses more complex indices like the CCI in certain scenarios, such as in glioblastoma-related outcomes. The study highlights that frailty indices are more predictive than age alone, advocating for their integration into preoperative evaluations to refine risk assessments and tailor treatment strategies. 25 , 26 Nair et al developed predictive models to evaluate the impact of frailty on postoperative outcomes in glioblastoma (GBM) patients, emphasizing the Modified Frailty Index (MFI-5) and Karnofsky Performance Status (KPS) as pivotal preoperative indicators. It highlights that increased frailty scores and lower KPS levels are strongly associated with extended hospital length of stay (LOS), nonroutine discharge, and elevated hospital charges, underscoring the profound influence of preoperative physical health status on post-surgical recovery and costs. 27 Frailty, quantified through the MFI-5, emerged as a critical determinant, with higher scores correlating significantly with longer LOS and more complex postoperative care needs. Similarly, a decrement in KPS not only predicted prolonged hospitalization but also identified patients more likely to incur higher healthcare costs and require non-routine discharge placements such as rehabilitation or skilled nursing facilities. These findings demonstrate the integral role of assessing frailty and functional status to anticipate and manage the challenges in the postoperative period effectively. 27 A recent study by Bray et al. conducted a retrospective chart review of 136 patients on frailty in patients with IDH-mutant gliomas. This study found no significant effect of mFI-5 on 30-day readmission nor in overall survival, except in individuals with de novo tumors. They labeled their patients as frail if they had an mFI-5 score of 1 or greater. Bray et al. also utilized CCI and found no significant alterations to 30-day readmission or OS. 28 Notably, this study examined patients with astrogliomas and oligodendrogliomas, populations distinct from our own by way of prognosis and severity. Youngerman et al. devised a study that used an expanded comorbidity-frailty calculation, mFI-11, to examine adverse outcomes in neuro-oncology patients undergoing surgical procedure. They found that surgeries were less likely to be performed at higher levels of frailty. They also found that higher levels of frailty were associated with increasing odds of complications, mortality, LOS, and NHD. In addition, they demonstrated the importance of age in these populations, as those over 65 years had higher odds of poor outcomes 29 . This data may lend itself to an understanding that not only are severely frail patients more likely to experience adverse outcomes, but they are also less likely to undergo the procedure to begin with. Our study has its limitations consistent with it’s retrospective nature including the possibility of confounding and selection bias. Our severely frail cohort is also very small which could be masking some of the differences between the frailty groups. Information was also gathered from charts made by many providers, which allows for further errors. While the mFI-5 has been shown many times to be an effective indicator of frailty, it is also important to note that it is directed by its limited data points, which may miss many peri-operative comorbidities that may be quintessential to determining neurosurgical post-operative outcomes. Our median age of diagnosis in our population was younger than what is observed in the literature. Once stratified into groups, it is also important to note that we had a relatively small size for our severely frail group. This may have limited the significance of our comparisons and therefore we may have encountered a type II error. Conclusion Frailty, measured by the mFI-5, predicts outcomes for GBM surgery. Higher mFI-5 scores are linked to increased complications and decreased 90-day survival. The mFI-5 helps identify high-risk patients who may benefit from enhanced recovery pathways or nonsurgical options like biopsy, radiation, or palliative care. Tables and Figures Table 1 Baseline demographics Baseline demographics Number (%) Age at resection 58.6 ± 11.3 BMI 29.15 ± 6.8 Gender n, (%) Male 110 (56.1) Female 86 (43.9) mFI-5 at components at presentation Hypertension 93 (47.4) Dependent status 21 (10.7) Diabetes 43 (21.9) COPD 8 (4.0) CHF 7 (3.6) Symptoms at presentation Headache 12 (6.1) Altered mental status 9 (4.6) Nausea 11 (5.6) Seizure 11 (5.6) Emesis 0 (0) Focal neurologic symptoms 39 (19.9) Confusion 50 (25.5) More than one symptom 50 (25.5) Admission/discharge Interval between admission and intervention (days) 2.42 ± 2.27 Tumor volume (cm) 1.8 ± 0.6 Length of surgery (min) 140 ± 34.4 Length of stay (days) 7.4 ± 6.4 Non-home discharge 84 (38.4) Post-operative complications (infection, pneumonia, neuro deficits) 57 (29.1) Median mRS at admission 1 Median mRS at discharge 1 BMI – body mass index, mFI-5 – modified 5-item frailty index, COPD – chronic obstructive pulmonary disease, CHF – congestive heart failure, mRS – modified rankin scale Table 2 Univariate Factors Associated with Frailty Comparison of Demographic Factors with Frailty Factor Prefrail (mFI 0–1) Frail (mFI 2) Severely Frail (mFI 3–5) p-value n = 147 n = 34 n = 12 Age at Surgery (years) 58.1 ± 12.5 59.9 ± 14.9 66.9 ± 13.1 0.0701 BMI 29.3 ± 7 28.9 ± 5.8 27.9 ± 6.5 0.767 Time from admission to intervention (days) 2.4 ± 2.2 3.1 ± 2.4 3.4 ± 2.8 0.14 Length of surgery (minutes) 197.7 ± 82.6 202.5 ± 66.2 208.5 ± 59.8 0.876 Gender 0.4201 Male 84 (57.14%) 16 (47.06%) 8 (66.67%) Female 63 (42.86%) 18 (52.94%) 4 (33.33%) Laterality 0.7458 Left 72 (48.98%) 20 (58.82%) 6 (50%) Right 67 (45.58%) 14 (41.18%) 6 (50%) NA 8 (5.44%) 0 (0%) 0 (0%) Focal Neuro Deficits 0.2297 No 73 (49.66%) 12 (35.29%) 4 (33.33%) Yes 69 (46.94%) 22 (64.71%) 8 (66.67%) NA 5 (3.4%) 0 (0%) 0 (0%) Altered Mental Status 0.03369 No 106 (72.11%) 16 (47.06%) 9 (75%) Yes 36 (24.49%) 18 (52.94%) 3 (25%) NA 5 (3.4%) 0 (0%) 0 (0%) Midline Shift Dimension (cm) 0.6 ± 0.5 0.7 ± 0.5 0.5 ± 0.5 0.409 Pre-op Tumor Size (cm) 4.3 ± 1.7 4.5 ± 1.2 3.7 ± 1.3 0.304 Peritumoral Edema (cm) 0.4 ± 0.4 0.4 ± 0.5 0.1 ± 0.3 0.0827 Peritumoral Edema 0.01319 Surgery Type 0.1221 Gross Total Resection 44 (29.93%) 13 (38.24%) 1 (8.33%) Subtotal Resection 95 (64.63%) 19 (55.88%) 11 (91.67%) NA 8 (5.44%) 2 (5.88%) 0 (0%) MGMT Methylation 0.01319 No 90 (61.22%) 22 (64.71%) 9 (75%) Yes 56 (38.1%) 11 (32.35%) 3 (25%) NA 1 (0.68%) 1 (2.94%) 0 (0%) Table 3 Univariate and Multivariate Factors Associated with Overall Survival; Cox Regression Univariate Multivariate Factor HR (95% CI) P Value HR (95% CI) P Value Frailty Frail 1.418 (0.9377, 2.145) 0.0979 1.4424 (0.8878, 2.343) 0.1390 Severely Frail 2.243 (1.1924, 4.221) 0.0122 1.0768 (0.4438, 2.613) 0.8701 BMI 1.019 (0.9925, 1.046) 0.162 Focal Neurologic Defects 1.814 (1.29, 2.552) 0.000625 1.4626 (0.9686, 2.209) 0.0705 Laterality (left vs right) 1.081 (0.777, 1.505) 0.642 Midline Shift (cm) 1.095 (0.7772, 1.54) 0.605 Age > 75 2.545 (1.502, 4.309) 0.000512 2.4080 (1.0566, 5.488) 0.0365 Gender (females vs males) 1.026 (0.7401, 1.423) 0.877 Altered mental status on admission 0.8849 (0.6156, 1.272) 0.509 Pre-op Tumor Size (cm) 0.9979 (0.9025, 1.103) 0.968 0.9038 (0.8013, 1.019) 0.0994 Peritumoral Edema (cm) 0.9278 (0.646, 1.333) 0.685 Peritumoral Edema 0.9789 (0.7057, 1.358) 0.899 Anticoagulation usage 2.356 (1.559, 3.561) < 0.0001 1.7084 (1.0349, 2.820) 0.0363 Table 4 Univariate and Multivariate Factors Associated with Progression Free Survival; Cox Regression Univariate Multivariate Factor HR (95% CI) P Value HR (95% CI) P Value Frailty Frail 1.279 (0.8413, 1.946) 0.2492 1.132 (0.6954, 1.842) 0.6184 Severely Frail 2.454 (1.3130, 4.586) 0.0049 2.054 (1.0161, 4.151) 0.0450 BMI 1.007 (0.9839, 1.031) 0.545 Focal Neurologic Defects 1.521 (1.104, 2.094) 0.0103 2.108 (1.1056, 4.019) 0.0400 Laterality (left vs right) 1.076 (0.7837, 1.478) 0.65 Midline Shift (cm) 1.36 (0.9827, 1.883) 0.0636 Age > 75 2.067 (1.206, 3.543) 0.0083 1.531 (1.0197, 2.298) 0.0235 Gender (females vs males) 1.004 (0.7344, 1.374) 0.978 Altered mental status on admission 1.009 (0.7149, 1.424) 0.96 Pre-op Tumor Size (cm) 0.9807 (0.891, 1.079) 0.691 Peritumoral Edema (cm) 0.9176 (0.6486, 1.298) 0.627 Peritumoral Edema 0.9083 (0.6643, 1.242) 0.547 Anticoagulation usage 1.821 (1.216, 2.726) 0.00363 Table 5 Incidence of Outcomes Across Frailty Group Outcomes by Frailty Prefrail (mFI 0–1) n = 147 Frail (mFI 2) n = 34 Severely Frail (mFI 3–5) n = 12 P Value Non-home discharge < 0.001 Home 99 (67.35%) 14 (41.18%) 3 (25%) Non-home 36 (24.49%) 19 (55.88%) 9 (75%) NA 12 (8.16%) 1 (2.94%) 0 (0%) Length of stay (days) 4.6 ± 4.4 7.5 ± 7.6 5 ± 3.1 0.0195 Resolution of preoperative symptoms 0.005839 No 37 (25.17%) 15 (44.12%) 8 (66.67%) Yes 98 (66.67%) 18 (52.94%) 4 (33.33%) NA 12 (8.16%) 1 (2.94%) 0 (0%) Postoperative neurologic deficits (new) 0.6022 No 25 (17.01%) 4 (11.76%) 1 (8.33%) Yes 31 (21.09%) 8 (23.53%) 3 (25%) NA 91 (61.9%) 22 (64.71%) 8 (66.67%) mRS at discharge > 2 (dependent) < 0.001 2 8 (5.44%) 9 (26.47%) 8 (66.67%) 30-day readmission 0.5523 No 88 (59.86%) 21 (61.76%) 10 (83.33%) Yes 18 (12.24%) 7 (20.59%) 2 (16.67%) NA 41 (27.89%) 6 (17.65%) 0 (0%) 90-day readmission 0.1594 No 77 (52.38%) 22 (64.71%) 6 (50%) Yes 28 (19.05%) 6 (17.65%) 6 (50%) NA 42 (28.57%) 6 (17.65%) 0 (0%) Overall Survival 0.507 Alive 31 (21.09%) 5 (14.71%) 1 (8.33%) Deceased 110 (74.83%) 29 (85.29%) 11 (91.67%) 30-day survival Alive 137 (93.2%) 32 (94.12%) 11 (91.67%) 0.06236 Deceased 1 (0.68%) 2 (5.88%) 1 (8.33%) 90-day survival 0.03524 Alive 131 (89.12%) 31 (91.18%) 9 (75%) Deceased 7 (4.76%) 3 (8.82%) 3 (25%) Declarations Statements & Declarations The authors declare that no funds, grants, or other support were received during the preparation of this manuscript Competing Interests The authors have no relevant financial or non-financial interests to disclose Author Contribution PGZ and MJS were responsible for study design, conceptualization, data collection planning, IRB writing, and submission. VP was responsible for helping with IRB writing and submission. JL was responsible for statistical design and analysis. PGZ, SH, LA, AM, JN, DE were responsible for data collection through chart review. All authors contributed to main manuscript writing, editing, formatting and figure preparation. Acknowledgement The authors thank Sarah Carey, MS, Jade Chang, and Jacalyn Newman, PhD, of Allegheny Health Network’s Health System Publication Support Office (HSPSO) for their assistance in editing and formatting the manuscript. The HSPSO is funded by Highmark Health (Pittsburgh, PA, United States of America), and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). References Sterckx W, Coolbrandt A, Dierckx de Casterlé B et al (2013) The impact of a high-grade glioma on everyday life: a systematic review from the patient's and caregiver's perspective. Eur J Oncol Nurs Feb 17(1):107–117. 10.1016/j.ejon.2012.04.006 Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med Mar 10(10):987–996. 10.1056/NEJMoa043330 Hancock JU, Price AL, Zaki PG, Graves JC, Locke KC, Luck T (2023) The Five-Factor Modified Frailty Index as a Predictor of Outcomes in Deep Brain Stimulation Surgery for Parkinson's Disease. Cureus Oct 15(10):e47547. 10.7759/cureus.47547 Zaki PG, Bolger J, Rogowski B et al (2023) The Utility of the 5 Factor Modified Frailty Index in Outcome Prediction for Patients with Chronic Subdural Hematoma Treated with Surgical Drainage. World Neurosurg Nov 179:e328–e341. 10.1016/j.wneu.2023.08.085 Santarius T, Lawton R, Kirkpatrick PJ, Hutchinson PJ (2008) The management of primary chronic subdural haematoma: a questionnaire survey of practice in the United Kingdom and the Republic of Ireland. Br J Neurosurg Aug 22(4):529–534. 10.1080/02688690802195381 Kazim SF, Dicpinigaitis AJ, Bowers CA et al (2022) Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients. Neurospine Mar 19(1):53–62. 10.14245/ns.2142770.385 Giaccherini L, Galaverni M, Renna I et al (2019) Role of multidimensional assessment of frailty in predicting outcomes in older patients with glioblastoma treated with adjuvant concurrent chemo-radiation. J Geriatr Oncol Sep 10(5):770–778. 10.1016/j.jgo.2019.03.009 Jimenez AE, Chakravarti S, Liu J et al (2024) The Hospital Frailty Risk Score Independently Predicts Postoperative Outcomes in Glioblastoma Patients. World Neurosurg Mar 183:e747–e760. 10.1016/j.wneu.2024.01.021 Mirpuri P, Singh M, Rovin RA (2022) The Association of Preoperative Frailty and Neighborhood-Level Disadvantage with Outcome in Patients with Newly Diagnosed High Grade Glioma. World Neurosurg Oct 166:e949–e957. 10.1016/j.wneu.2022.07.138 Krupa M (2009) [Chronic subdural hematoma: a review of the literature. Part 1]. Ann Acad Med Stetin 55(2):47–52 Rahmani R, Tomlinson SB, Santangelo G et al (2020) Risk factors associated with early adverse outcomes following craniotomy for malignant glioma in older adults. J Geriatr Oncol May 11(4):694–700. 10.1016/j.jgo.2019.10.019 Cloney M, D'Amico R, Lebovic J et al (2016) Frailty in Geriatric Glioblastoma Patients: A Predictor of Operative Morbidity and Outcome. World Neurosurg May 89:362–367. 10.1016/j.wneu.2015.12.096 Krenzlin H, Jankovic D, Alberter C et al (2021) Frailty in Glioblastoma Is Independent From Chronological Age. Front Neurol 12:777120. 10.3389/fneur.2021.777120 Subramaniam S, Aalberg JJ, Soriano RP, Divino CM (Feb 2018) New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data. J Am Coll Surg 226(2):173–181e8. 10.1016/j.jamcollsurg.2017.11.005 Sastry RA, Pertsch N, Tang O, Shao B, Toms SA, Weil RJ (2021) Frailty and Outcomes after Craniotomy or Craniectomy for Atraumatic Chronic Subdural Hematoma. World Neurosurg Jan 145:e242–e251. 10.1016/j.wneu.2020.10.022 Kim M, Ladomersky E, Mozny A et al (2021) Glioblastoma as an age-related neurological disorder in adults. Neurooncol Adv 3(1):vdab125. 10.1093/noajnl/vdab125 Ostrom QT, Patil N, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS (2020) CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013–2017. Neuro Oncol Oct 30(12 Suppl 2):iv1–iv96. 10.1093/neuonc/noaa200 Sales AHA, Beck J, Schnell O, Fung C, Meyer B, Gempt J (2022) Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends. J Clin Med Sep 13(18). 10.3390/jcm11185354 Voisin MR, Sasikumar S, Zadeh G (2021) Predictors of survival in elderly patients undergoing surgery for glioblastoma. Neurooncol Adv 3(1):vdab083. 10.1093/noajnl/vdab083 Mohan DS, Suh JH, Phan JL, Kupelian PA, Cohen BH, Barnett GH (1998) Outcome in elderly patients undergoing definitive surgery and radiation therapy for supratentorial glioblastoma multiforme at a tertiary care institution. Int J Radiat Oncol Biol Phys Dec 01(5):981–987. 10.1016/s0360-3016(98)00296-x Vengoji R, Macha MA, Batra SK, Shonka NA (2018) Natural products: a hope for glioblastoma patients. Oncotarget Apr 24(31):22194–22219. 10.18632/oncotarget.25175 Wu A, Ruiz Colón G, Aslakson R, Pollom E, Patel CB (2021) Palliative Care Service Utilization and Advance Care Planning for Adult Glioblastoma Patients: A Systematic Review. Cancers (Basel) Jun 08(12). 10.3390/cancers13122867 Kreth FW, Warnke PC, Scheremet R, Ostertag CB (1993) Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg May 78(5):762–766. 10.3171/jns.1993.78.5.0762 Huq S, Khalafallah AM, Jimenez AE et al (2020) Predicting Postoperative Outcomes in Brain Tumor Patients With a 5-Factor Modified Frailty Index. Neurosurg Dec 15(1):147–154. 10.1093/neuros/nyaa335 Aghajanian S, Shafiee A, Ahmadi A, Elsamadicy AA (2023) Assessment of the impact of frailty on adverse surgical outcomes in patients undergoing surgery for intracranial tumors using modified frailty index: A systematic review and meta-analysis. J Clin Neurosci Aug 114:120–128. 10.1016/j.jocn.2023.06.013 Schneider M, Potthoff AL, Scharnböck E et al (2020) Newly diagnosed glioblastoma in geriatric (65 +) patients: impact of patients frailty, comorbidity burden and obesity on overall survival. J Neurooncol Sep 149(3):421–427. 10.1007/s11060-020-03625-2 Nair SK, Chakravarti S, Jimenez AE et al (2022) May. Novel Predictive Models for High-Value Care Outcomes Following Glioblastoma Resection. World Neurosurg . ;161:e572-e579. 10.1016/j.wneu.2022.02.064 Bray D, Stubbs N, Chow J et al (2024) Frailty in Patients With IDH-Mutant Gliomas. Experience from a High-Volume Tumor Center Youngerman BE, Neugut AI, Yang J, Hershman DL, Wright JD, Bruce JN (2018) The modified frailty index and 30-day adverse events in oncologic neurosurgery. J Neurooncol Jan 136(1):197–206. 10.1007/s11060-017-2644-0 Additional Declarations No competing interests reported. Supplementary Files SupplementalMaterialGBM.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Shepard","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYJACZjApAWHLQRl4NTA2I2sxJl1LYgMhLbrt548/Lqg4zCA/u/nYg597rNP7Z/ceYPi4pxanFrMzyYzNM84cZjC4cyzdsOdZeu6MO+cSGGc8O45bywGgFt622wwGEjlmEjwHDuc23MgxYOY5cAy3lvOPgVr+3WaQn5H/TfLPgcPp8gS13ADZ0nCbgeFGDps00JYEA4iWGjxaHhvO5jn2n8fgRpq5scyBdMONQC0HZxw4gMdhiQ8+89SkycnPSH728M0Ba3m5GzmGDz4cqMOpBQZ4gJgNzgNacZigFgYULUBA2JZRMApGwSgYMQAAy7xcCfwCO0oAAAAASUVORK5CYII=","orcid":"","institution":"Allegheny General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Matthew","middleName":"J.","lastName":"Shepard","suffix":""}],"badges":[],"createdAt":"2024-05-16 18:56:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4432842/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4432842/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57519204,"identity":"5f2756d3-03cb-4151-8bb7-05cb6c630f08","added_by":"auto","created_at":"2024-05-31 20:39:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11178,"visible":true,"origin":"","legend":"\u003cp\u003eOverall Survival stratified by Frailty\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4432842/v1/3d1f5ad6f5e0df9beca88857.png"},{"id":57519207,"identity":"2a6f9e3e-c65c-46ff-82f2-494a84e3ecb2","added_by":"auto","created_at":"2024-05-31 20:39:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30604,"visible":true,"origin":"","legend":"\u003cp\u003eProgression Free Survival stratified by Frailty\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4432842/v1/c6a94eafd245ab87ec7e606e.png"},{"id":57985142,"identity":"0bf4513b-73b6-4615-a11c-e931e0b7bb76","added_by":"auto","created_at":"2024-06-08 19:31:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1082150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4432842/v1/a0fbe162-b5c0-4e52-8726-061b1e00cafb.pdf"},{"id":57519205,"identity":"da23759a-f6b4-4094-ac05-b6ab9f468ec8","added_by":"auto","created_at":"2024-05-31 20:39:18","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":42925,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalMaterialGBM.docx","url":"https://assets-eu.researchsquare.com/files/rs-4432842/v1/584723b20c4ce5e548d9bf0c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHigh grade gliomas (HGGs), currently termed astrocytoma IDH-mutant grade 4, are rare, aggressive primary brain tumors that are associated with poor outcomes.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The standard treatment for HGGs remains maximal safe surgical resection followed by adjuvant external beam radiotherapy and temozolomide.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e For patients to tolerate adjuvant chemotherapy/radiation, however, patients must first recover sufficiently from surgery with an acceptable performance status. It is therefore crucial to explore variables that may be negative prognostic indicators for patients prior to surgical resection.\u003c/p\u003e \u003cp\u003eAn emerging area of interest is the role of patient frailty in predicting postoperative outcomes\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Increasingly, patient frailty is being recognized as a crucial factor influencing outcomes after various surgical procedures, including those in surgical-oncology and orthopedic surgery.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Recently, frailty has been investigated as a predictor for outcomes of patients with HGGs treated with surgery and adjuvant therapy.\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e–\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Research has consistently shown a correlation between frailty metrics and postoperative outcomes.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The predictive value of frailty and other risk factors has been specifically investigated in older adults undergoing surgical treatment for HGGs as age is an additional risk factor excluded from the mFI-5 that may impact outcomes of surgery in this population.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Greater frailty specifically has been identified as a predictor of greater risk of complications and decreased survival in older adults that have undergone surgery for HGGs.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Traditionally, multifactor indices such as the Charlson Comorbidity Index (CCI), the mFI-9, and the mFI-11 have been used to assess frailty. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e These indices, while thorough, can be complex to calculate and often require data not always readily available in-patient records, making real-time clinical decision-making challenging.\u003c/p\u003e \u003cp\u003eTo address these limitations a streamlined, validated measure known as the 5-factor modified frailty index (mFI-5) has been developed. This index simplifies the evaluation process by assigning points based on five key variables: the need for assistance with daily living activities, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, and hypertension. Emerging studies utilizing the mFI-5 have demonstrated a clear link between higher levels of preoperative frailty and increased risks of adverse postoperative outcomes.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e This underscores the importance of incorporating frailty assessment in preoperative planning to improve patient outcomes and for pre-operative patient counseling.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe purpose of this study is to evaluate whether increasing mFI-5 scores are associated with increased peri-operative morbidity and OS for patients with newly diagnosed HGGs.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003e A retrospective chart review was conducted on patients undergoing HGG surgery at our institution between 2016 and 2023. Included were patients 18 years or older with Grade IV IDH-WT astrocytoma (glioblastoma) who had at least 30 days of post-operative follow-up. Excluded were those without sufficient pre-operative clinical information for mFI-5 scores.\u003c/p\u003e\u003cp\u003e Institutional Review Board approval and informed consent were obtained.\u003c/p\u003e\u003cp\u003eClinical and radiographic data included demographics, surgical details, overall survival (OS), length of stay (LOS), readmission and reoperation rates, non-home disposition (NHD), and discharge modified Rankin Scale (mRS) scores. MRI scans were reviewed for tumor size (RANO), recurrence, and peritumoral edema.\u003c/p\u003e\u003cp\u003eData was censored at last follow-up or death. Primary outcomes were 30-day, 90-day, 6-month, and 1-year survival and progression-free survival (PFS). Secondary outcomes included 30-day readmission, NHD, LOS, new neurologic deficits, resolution of preoperative deficits, and discharge mRS \u0026gt; 2.\u003c/p\u003e\u003cp\u003eThe mFI-5 score stratified patients into prefrail (mFI-5 \u0026lt; 2), frail (mFI-5 = 2), and severely frail (mFI-5 \u0026gt; 2).\u003c/p\u003e\u003cp\u003eUnivariate comparisons used t-tests and chi-squared/Fisher’s exact tests. Cox regressions determined factors for tumor recurrence, 90-day PFS, OS, and 90-day survival. Logistic regressions predicted NHD, symptom resolution, and mRS \u0026gt; 2. Linear regression predicted LOS. Stepwise selection chose variables for multivariate analysis. A p-value \u0026lt; 0.05 was significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient Demographics\u003c/h2\u003e \u003cp\u003e196 patients underwent surgical resection of a HGG and are included in this analysis. In this analyzed population, the mean age at resection was 58.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3 with a male predominance (101/196, 56.1%). The most common symptoms at admission were confusion (50/196, 22.9%) or focal neurologic deficit (FND) (39/196, 19.9%). 22.9% of patients had more than one symptom at presentation (50/196, 22.9%) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Patients underwent intervention within 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 days from admission, with average tumor volume being 1.8cm\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6. Surgery length on average took 140\u0026thinsp;\u0026plusmn;\u0026thinsp;34.4 minutes. Mean length of stay (LOS) was 7.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4 days. 38.4% of patients were discharged to either a subacute nursing facility or rehab center. 29.1% had a post-op complication of either urinary tract infection (3/196, 1.5%), pneumonia (6/196, 3.1%), or DVT (16/196, 8.2%), Pulmonary embolism (4/196, 2.0%), new neurologic deficit (28/196, 14.3%). Resolution of preoperative symptoms was 66.7% for prefrail, 52.9% frail, and 33.3% severely frail, which was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Median mRS did not change from admission to discharge. Population demographics are in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eComparison of Baseline Demographics Amongst Frailty Groups\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the basic demographics of patients with different frailty scores. 76.2% (147/193) of patients had a mFI score 0\u0026ndash;1, classified as prefrail, 17.6% (34 /193) had a mFI score of 2, classified as frail, and 6.2% (12/193) had an mFI score of 3\u0026ndash;5, classified as severely frail. The difference between the age of these three frailty groups (prefrail 58.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5, frail 59.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9, and severely frail 66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1) was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.07) although there was a tendency for patients in the severely frail cohort to be older. Patients in the frail cohort tended to have increased rates of altered mental status upon initial presentation (52.9% versus 25.5%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Midline shift, tumor size and peritumoral edema amount were not significantly different between groups. The prefrail and frail groups had increased rated of peritumoral edema compared to severely frail group (59.8% of prefrail, 58.8% of frail, and 16.6% of severely frail patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01)). A history of anticoagulation use had statistical significance with 13.6% of prefrail, 38.2% of frail, and 33.3% of severely frail (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The rates of gross total resection (GTR) among the prefrail, frail and severely frail were (29.9%, 38.2%, and 8.3%, respectively) while the rates of subtotal (STR) resection were (64.6%, 55.9%, 91.7%, respectively) and these rates were not statistically significant among the three frailty groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePrimary outcomes\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eOverall Survival\u003c/h2\u003e \u003cp\u003eThe 30-day survival rate was not statistically different between groups. However, the 90-day survival rates were notably improved in the pre-frail/frail cohorts compared to the severely frail patients (90 day OS: 89.1%, 91.2%, 75% of prefrail, frail, and severely frail groups, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The median survival for the cohort was 17.9 months in the prefrail, 15.4 months in the frail and 15.3 in the severely frail (p\u0026thinsp;=\u0026thinsp;0.02) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eUnivariate and Multivariate Factors Associated with Survival\u003c/h2\u003e \u003cp\u003eAge\u0026thinsp;\u0026gt;\u0026thinsp;75 (Univariate: HR 2.5, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; multivariate: HR: 2.4, P\u0026thinsp;=\u0026thinsp;0.03) and anticoagulation use (Univariate: HR 2.3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; multivariate: HR: 1.7, P\u0026thinsp;=\u0026thinsp;0.03) were independent predictors of OS in the univariate and multivariate analyses. Being severely frail (Univariate: HR 2.2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01; multivariate: HR: 1.1, P\u0026thinsp;=\u0026thinsp;0.8), and having post-operative FND (Univariate: HR 1.8, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; multivariate: HR: 1.5, P\u0026thinsp;=\u0026thinsp;0.07) were only predictors in the univariate analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 90 Day survival rate for individuals in the severely frail cohort was significantly decreased in both univariate and multivariate analysis (HR 6.1; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and HR 6.8; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, \u003cb\u003erespectively) Supplemental Table\u0026nbsp;1\u003c/b\u003e. Additionally, in the univariate analysis having FND (HR 4.7; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and anti-coagulation use (HR 3.8; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were associated with a decreased likelihood of 90 Day survival. In the multivariate analysis pre-op tumor size was associated with decreased likelihood of 90 Day survival (HR 0.6; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003ePost-operative FND (Univariate: HR 3.0, P\u0026thinsp;=\u0026thinsp;0.006; multivariate: HR: 3.2, P\u0026thinsp;=\u0026thinsp;0.02) and age\u0026thinsp;\u0026gt;\u0026thinsp;75 (Univariate: HR 3.9, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; multivariate: HR: 3.5, P\u0026thinsp;=\u0026thinsp;0.02) continued to be independent predictors of survival at 6 months Supplemental Table\u0026nbsp;2. At 12 months, only age remained an independent predictor of survival (Univariate: HR 2.5, P\u0026thinsp;=\u0026thinsp;0.01; multivariate: HR: 3.6, P\u0026thinsp;=\u0026thinsp;0.004) Supplemental Table\u0026nbsp;3.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eProgression Free Survival\u003c/h2\u003e \u003cp\u003eThe median PFS was 9.2 months in the prefrail group, 6.9 months in the frail group and 3.5 months in the severely frail group \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Severe frailty (Univariate: HR 2.4, P\u0026thinsp;=\u0026thinsp;0.005; multivariate: HR: 2.0, P\u0026thinsp;=\u0026thinsp;0.04), age\u0026thinsp;\u0026gt;\u0026thinsp;75 (Univariate: HR 2.1, P\u0026thinsp;=\u0026thinsp;0.005; multivariate: HR: 1.5, P\u0026thinsp;=\u0026thinsp;0.04), and post-operative FND (Univariate: HR 1.5, P\u0026thinsp;=\u0026thinsp;0.008; multivariate: HR: 2.1, P\u0026thinsp;=\u0026thinsp;0.02) were the only factors that were independent predictors of PFS in the univariate and multivariate analyses \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003e)\u003c/b\u003e supporting the fact that severely frail patients, older than 75 with post-operative FND are less likely to survive without progression of their disease.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSecondary outcomes\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section4\"\u003e \u003ch2\u003eDisposition and Length of Stay\u003c/h2\u003e \u003cp\u003eThere was a notable increase in the likelihood of NHD status in the frail (19/34, 55.9%) and severely frail (9/12, 75%) cohorts compared to the prefrail cohort (36/147, 24.5%) (CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The overall non-home discharge for the entire cohort was 32.7% (64/196). (CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eFactors associated with NHD status on univariate analysis and multivariate analysis were frail (Odds Ratio [OR] 3.7; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and OR 3.8; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively), severely frail (OR 8.3; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and OR 6.9; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, respectively), age\u0026thinsp;\u0026gt;\u0026thinsp;75 (OR 11.5; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, and OR 9.2; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively). Anticoagulant use was only associated on univariate analysis (OR 3.4; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The only factor associated with home discharge was gender on univariate (OR 0.49 CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and multivariate analysis (OR 0.48; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) \u003cb\u003eSupplemental Table\u0026nbsp;4\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe median length of stay was 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 for prefrail, 7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6 for frail, and 5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1 severely frail (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Factors associated with a longer length of stay on univariate analysis and multivariate analysis were frail (Parameter Estimate (PE) 2.82; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and PE 2.74; CPH regression P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, respectively) and age\u0026thinsp;\u0026gt;\u0026thinsp;75 (PE 3.07; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and PE 3.74; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively) Supplemental Table\u0026nbsp;5 .There was a notable increase in the likelihood of mRS\u0026thinsp;\u0026gt;\u0026thinsp;2 status at discharge in the frail (9/34, 26.5%) and severely frail (8/12, 66.7%) cohorts compared to the prefrail cohort (8/147, 5.4%) (CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The overall patients discharged with mRS\u0026thinsp;\u0026gt;\u0026thinsp;2 for the entire cohort was 12.8% (25/196). Factors associated with mRS\u0026thinsp;\u0026gt;\u0026thinsp;2 at discharge on univariate analysis and multivariate analysis were frail (OR 6.25; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and OR 13.53; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively) and severely frail (OR 34.75; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and OR 87.5; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, respectively).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSymptomatic Resolution\u003c/h2\u003e \u003cp\u003eThe overall resolution of pre-op symptoms for the entire cohort was 61.22% (120/196). The resolution rate was 66.67% (98/147), 52.94% (18/34), and 33.33% (4/12) for the prefrail, frail, and severely frail cohorts (CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), respectively Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eOn univariate analysis and multivariate analysis, frail (OR 0.45; CPH regression p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and OR 0.42; CPH regression p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, respectively) and severely frail (OR 0.19, CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 and OR 0.23; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, respectively) patients were less likely to demonstrate resolution of pre-op symptoms. Peritumoral edema size was only associated with an increased likelihood of pre-op symptom resolution on univariate analysis (OR 2.16; CPH p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) Supplemental \u003cb\u003eTable\u0026nbsp;7.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eReadmission rates and time to adjuvant therapy (chemotherapy, radiation)\u003c/h2\u003e \u003cp\u003eNone of the analyzed variables were independent predictors of time to adjuvant therapy with median time to adjuvant therapy (42 days, 39 days, and 34 days in the prefrail, frail and severely frail respectively) Supplemental \u003cb\u003eTable\u0026nbsp;8.\u003c/b\u003e Furthermore, only tumor laterality was associated with 30-day readmission \u003cb\u003e(\u003c/b\u003eUnivariate: HR 2.7, P\u0026thinsp;=\u0026thinsp;0.02; multivariate: HR: 4.7, p\u0026thinsp;=\u0026thinsp;0.003) while no factors were associated with 90-day readmission in our cohort Supplemental \u003cb\u003eTable\u0026nbsp;9 ,10.\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eDue to increased life expectancy of older generations and technological advancements in diagnostic methods, the incidence and prevalence of GBM are expected to increase\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The median age of diagnosis falls between 68\u0026ndash;70 years\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The outcomes of patients undergoing resection for GBM have been previously reported within different patient populations with varied OS and PFS rates.\u003csup\u003e\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Despite improvements in the pathogenesis of HGGs, the median OS/PFS for HGGs has changed little in the past several decades. It is therefore increasingly important to identify prognostic factors that are agnostic to the underlying tumor biology and to identify a priori which patients may benefit from aggressive upfront surgery versus those who are unlikely to benefit from aggressive surgical excision\u003csup\u003e\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Evidence from the current literature and our institutional experience underscores the varied perioperative outcomes for patients undergoing resection for GBM. This retrospective study sought to demonstrate the predictive ability of the mFI-5 score on postoperative patient outcomes following surgical resection of GBM.\u003c/p\u003e \u003cp\u003eWhile there was no significant impact of frailty on median OS on multivariate analysis, our results found a significant correlation between frailty and increased mortality at 90-days. These results suggest that patients in the frail and severely frail cohorts are less likely to survive the immediate peri-operative period, but if they do, their oncologic outcomes with respect to longevity mirror those in the pre-frail cohort. Along these lines, severely frail patients were less likely to recover from their admission symptoms post-operatively, and more likely discharged to rehab or subacute nursing centers. Frail and severely frail patients were likewise less likely to have improvement in their pre-operative symptoms, shown by an increased mRS on discharge. Most intriguing, our results suggest that patients with higher frailty scores have diminished PFS after surgery. We hypothesize that frail individuals are less likely to tolerate adjuvant chemotherapy/radiation and therefore have earlier tumor recurrence. Introducing enhanced recovery pathways into the care of patients with gliomas may help overcome this and is a subject of future research.\u003c/p\u003e \u003cp\u003eOur findings are consistent with previous literature and support the hypothesis that increasing frailty can have detrimental effects on patient postoperatively. Huq et al., investigated the effects of frailty using different frailty indicators (CCI, mFI-11 and mFI-5) and found that increased frailty was associated with increased complications rate postoperatively in brain tumor patients.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSepher et al underscore the impact of frailty on postoperative outcomes in neurosurgical patients with brain tumors, emphasizing that higher frailty scores significantly correlate with increased risks of complications, mortality, readmission, and the need for reoperation. Notably, the mFI-5 and mFI-11, despite their simplicity, demonstrate a predictive strength that rivals or surpasses more complex indices like the CCI in certain scenarios, such as in glioblastoma-related outcomes. The study highlights that frailty indices are more predictive than age alone, advocating for their integration into preoperative evaluations to refine risk assessments and tailor treatment strategies.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNair et al developed predictive models to evaluate the impact of frailty on postoperative outcomes in glioblastoma (GBM) patients, emphasizing the Modified Frailty Index (MFI-5) and Karnofsky Performance Status (KPS) as pivotal preoperative indicators. It highlights that increased frailty scores and lower KPS levels are strongly associated with extended hospital length of stay (LOS), nonroutine discharge, and elevated hospital charges, underscoring the profound influence of preoperative physical health status on post-surgical recovery and costs.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Frailty, quantified through the MFI-5, emerged as a critical determinant, with higher scores correlating significantly with longer LOS and more complex postoperative care needs. Similarly, a decrement in KPS not only predicted prolonged hospitalization but also identified patients more likely to incur higher healthcare costs and require non-routine discharge placements such as rehabilitation or skilled nursing facilities. These findings demonstrate the integral role of assessing frailty and functional status to anticipate and manage the challenges in the postoperative period effectively.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA recent study by Bray et al. conducted a retrospective chart review of 136 patients on frailty in patients with IDH-mutant gliomas. This study found no significant effect of mFI-5 on 30-day readmission nor in overall survival, except in individuals with de novo tumors. They labeled their patients as frail if they had an mFI-5 score of 1 or greater. Bray et al. also utilized CCI and found no significant alterations to 30-day readmission or OS.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e Notably, this study examined patients with astrogliomas and oligodendrogliomas, populations distinct from our own by way of prognosis and severity.\u003c/p\u003e \u003cp\u003eYoungerman et al. devised a study that used an expanded comorbidity-frailty calculation, mFI-11, to examine adverse outcomes in neuro-oncology patients undergoing surgical procedure. They found that surgeries were less likely to be performed at higher levels of frailty. They also found that higher levels of frailty were associated with increasing odds of complications, mortality, LOS, and NHD. In addition, they demonstrated the importance of age in these populations, as those over 65 years had higher odds of poor outcomes\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. This data may lend itself to an understanding that not only are severely frail patients more likely to experience adverse outcomes, but they are also less likely to undergo the procedure to begin with.\u003c/p\u003e \u003cp\u003eOur study has its limitations consistent with it\u0026rsquo;s retrospective nature including the possibility of confounding and selection bias. Our severely frail cohort is also very small which could be masking some of the differences between the frailty groups. Information was also gathered from charts made by many providers, which allows for further errors. While the mFI-5 has been shown many times to be an effective indicator of frailty, it is also important to note that it is directed by its limited data points, which may miss many peri-operative comorbidities that may be quintessential to determining neurosurgical post-operative outcomes. Our median age of diagnosis in our population was younger than what is observed in the literature. Once stratified into groups, it is also important to note that we had a relatively small size for our severely frail group. This may have limited the significance of our comparisons and therefore we may have encountered a type II error.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFrailty, measured by the mFI-5, predicts outcomes for GBM surgery. Higher mFI-5 scores are linked to increased complications and decreased 90-day survival. The mFI-5 helps identify high-risk patients who may benefit from enhanced recovery pathways or nonsurgical options like biopsy, radiation, or palliative care.\u003c/p\u003e \u003cp\u003eTables and Figures\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaseline demographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.6\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;11.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.15\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender n, (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (56.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86 (43.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emFI-5 at components at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (47.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (10.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (21.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (4.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (3.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSymptoms at presentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAltered mental status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeizure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (5.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFocal neurologic symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (19.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (25.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than one symptom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (25.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdmission/discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterval between admission and intervention (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.42\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor volume (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of surgery (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;34.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-home discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (38.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-operative complications (infection, pneumonia, neuro deficits)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (29.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian mRS at admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian mRS at discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBMI \u0026ndash; body mass index, mFI-5 \u0026ndash; modified 5-item frailty index, COPD \u0026ndash; chronic obstructive pulmonary disease, CHF \u0026ndash; congestive heart failure, mRS \u0026ndash; modified rankin scale\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Factors Associated with Frailty Comparison of Demographic Factors with Frailty\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefrail (mFI 0\u0026ndash;1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrail (mFI 2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeverely Frail (mFI 3\u0026ndash;5)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at Surgery (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.9\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime from admission to intervention (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of surgery (minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e197.7\u0026thinsp;\u0026plusmn;\u0026thinsp;82.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202.5\u0026thinsp;\u0026plusmn;\u0026thinsp;66.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208.5\u0026thinsp;\u0026plusmn;\u0026thinsp;59.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.4201\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (57.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (47.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (66.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (42.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (52.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaterality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (48.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (58.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (45.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (41.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (5.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eFocal Neuro Deficits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (49.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (35.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (46.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (64.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (66.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAltered Mental Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.03369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106 (72.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (47.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (24.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (52.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidline Shift Dimension (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op Tumor Size (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.304\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritumoral Edema (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0827\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritumoral Edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGross Total Resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (29.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (38.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtotal Resection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (64.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (55.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (91.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (5.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eMGMT Methylation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.01319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (61.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (64.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (32.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (0.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and Multivariate Factors Associated with Overall Survival; Cox Regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFrailty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.418 (0.9377, 2.145)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0979\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4424 (0.8878, 2.343)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.1390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeverely Frail\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.243 (1.1924, 4.221)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.0122\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0768 (0.4438, 2.613)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8701\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.019 (0.9925, 1.046)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFocal Neurologic Defects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1.814 (1.29, 2.552)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000625\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4626 (0.9686, 2.209)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaterality (left vs right)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.081 (0.777, 1.505)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidline Shift (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.095 (0.7772, 1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u0026thinsp;\u0026gt;\u0026thinsp;75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.545 (1.502, 4.309)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000512\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.4080 (1.0566, 5.488)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0365\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (females vs males)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.026 (0.7401, 1.423)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAltered mental status on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.8849 (0.6156, 1.272)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op Tumor Size (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9979 (0.9025, 1.103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9038 (0.8013, 1.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritumoral Edema (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9278 (0.646, 1.333)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritumoral Edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9789 (0.7057, 1.358)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnticoagulation usage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2.356 (1.559, 3.561)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1.7084 (1.0349, 2.820)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0363\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and Multivariate Factors Associated with Progression Free Survival; Cox Regression\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eFrailty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.279 (0.8413, 1.946)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.132 (0.6954, 1.842)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverely Frail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.454 (1.3130, 4.586)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.054 (1.0161, 4.151)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0450\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.007 (0.9839, 1.031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFocal Neurologic Defects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.521 (1.104, 2.094)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.108 (1.1056, 4.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaterality (left vs right)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.076 (0.7837, 1.478)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMidline Shift (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.36 (0.9827, 1.883)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026gt;\u0026thinsp;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.067 (1.206, 3.543)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.531 (1.0197, 2.298)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (females vs males)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.004 (0.7344, 1.374)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAltered mental status on admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.009 (0.7149, 1.424)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op Tumor Size (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9807 (0.891, 1.079)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritumoral Edema (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9176 (0.6486, 1.298)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritumoral Edema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9083 (0.6643, 1.242)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulation usage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.821 (1.216, 2.726)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of Outcomes Across Frailty Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes by Frailty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefrail (mFI 0\u0026ndash;1)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;147\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrail (mFI 2)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;34\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeverely Frail (mFI 3\u0026ndash;5)\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-home discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHome\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e99 (67.35%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e14 (41.18%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3 (25%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-home\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e36 (24.49%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e19 (55.88%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e9 (75%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e12 (8.16%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1 (2.94%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0 (0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of stay (days)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.0195\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResolution of preoperative symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005839\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e37 (25.17%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e15 (44.12%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e8 (66.67%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e98 (66.67%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e18 (52.94%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e4 (33.33%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e12 (8.16%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1 (2.94%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0 (0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative neurologic deficits (new)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (17.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (11.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (21.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (23.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (64.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (66.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emRS at discharge\u0026thinsp;\u0026gt;\u0026thinsp;2 (dependent)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;= 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139 (94.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (73.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (5.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (26.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (66.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e30-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.5523\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88 (59.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (61.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (83.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (12.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (20.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (16.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (27.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (17.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e90-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1594\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e77 (52.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (64.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (19.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (17.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42 (28.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (17.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eOverall Survival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.507\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (21.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (14.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e110 (74.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (85.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (91.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e30-day survival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e137 (93.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (94.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (91.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.06236\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (8.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e90-day survival\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03524\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e131 (89.12%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e31 (91.18%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e9 (75%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDeceased\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e7 (4.76%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3 (8.82%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3 (25%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Declarations","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStatements \u0026amp; Declarations\u003c/h2\u003e \u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript\u003c/p\u003e \u003c/div\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePGZ and MJS were responsible for study design, conceptualization, data collection planning, IRB writing, and submission. VP was responsible for helping with IRB writing and submission. JL was responsible for statistical design and analysis. PGZ, SH, LA, AM, JN, DE were responsible for data collection through chart review. All authors contributed to main manuscript writing, editing, formatting and figure preparation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors thank Sarah Carey, MS, Jade Chang, and Jacalyn Newman, PhD, of Allegheny Health Network\u0026rsquo;s Health System Publication Support Office (HSPSO) for their assistance in editing and formatting the manuscript. The HSPSO is funded by Highmark Health (Pittsburgh, PA, United States of America), and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSterckx W, Coolbrandt A, Dierckx de Casterl\u0026eacute; B et al (2013) The impact of a high-grade glioma on everyday life: a systematic review from the patient's and caregiver's perspective. Eur J Oncol Nurs Feb 17(1):107\u0026ndash;117. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejon.2012.04.006\u003c/span\u003e\u003cspan address=\"10.1016/j.ejon.2012.04.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. 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J Neurooncol Jan 136(1):197\u0026ndash;206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11060-017-2644-0\u003c/span\u003e\u003cspan address=\"10.1007/s11060-017-2644-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"high-grade glioma, glioblastoma, frailty, Modified Frailty Index, surgical outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4432842/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4432842/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHigh-grade gliomas (HGGs) are aggressive brain tumors associated with significant morbidity. This study aims to assess the utility of the 5-factor Modified Frailty Index (mFI-5) in predicting postoperative outcomes and overall survival in patients undergoing surgical resection for HGGs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe conducted a retrospective analysis of 196 patients treated surgically for GBM at our institution from January 2016 to January 2023. Patients were stratified into three groups based on their preoperative mFI-5 scores: prefrail (\u0026lt;\u0026thinsp;2), frail (=\u0026thinsp;2), and severely frail (\u0026gt;\u0026thinsp;2). Primary outcomes included 30-day, 90-day, and 1-year survival and progression-free survival. Secondary outcomes focused on hospital length of stay (LOS), 30-day readmission rates, and discharge status. Univariate and multivariate analyses evaluated the impact of frailty on these outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFrailty was significantly associated with adverse outcomes. The median progression free survival was 9.2 months in the prefrail, 6.9 months in the frail and 3.5 months in severely frail patients (p\u0026thinsp;=\u0026thinsp;0.01). Furthermore, the 90-day OS was 89%, 91% and 75% for the prefrail, frail and severely frail group respectively (p\u0026thinsp;=\u0026thinsp;0.03). However, there was no statistically significant difference in 12-month OS (64%, 70%, 58%; p\u0026thinsp;=\u0026thinsp;0.72). The median survival for the cohort was 17.9 months in the prefrail, 15.4 months in the frail and 15.3 in the severely frail (p\u0026thinsp;=\u0026thinsp;0.02). Severely frail patients demonstrated lower rates of symptomatic resolution (66%,53%, 33% respectively; p\u0026thinsp;=\u0026thinsp;0.005), increased non-home discharge rates (24%, 55.9%, 75%, respectively; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and mRS\u0026thinsp;\u0026gt;\u0026thinsp;2 upon discharge (5%, 26%, and 66% respectively; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe mFI-5 is a valuable tool for preoperative risk stratification in patients with GBM, predicting short-term survival and postoperative outcomes. Integrating frailty assessments into preoperative evaluations can aid in tailoring surgical and adjuvant therapies, potentially improving patient outcomes and optimizing resource allocation. This study supports the adoption of frailty assessments in neuro-oncological practice to enhance personalized care strategies for patients with HGGs.\u003c/p\u003e","manuscriptTitle":"Evaluating the Predictive Value of the Modified Frailty Index (mFI-5) on Postoperative Outcomes in Patients with High-Grade Gliomas","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-31 20:39:13","doi":"10.21203/rs.3.rs-4432842/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aa50b99e-67ad-4d8b-8de2-9ff9b11ef0fe","owner":[],"postedDate":"May 31st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-08T19:23:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-31 20:39:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4432842","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4432842","identity":"rs-4432842","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}