OBJECT The Simpson grading system has played an important role in the surgical resections of meningiomas. This study set out to determine if this grading system predicts meningioma recurrence in a modern cohort of patients with tumors of all World Health Organization (WHO) grades. METHODS Adult patients who underwent primary, non-biopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate proportional hazard analyses were used to identify associations with recurrence following resection. Log-rank analyses were used to compare Kaplan-Meier plots for time to recurrence between each Simpson grade. RESULTS Of the 572 patients who met the inclusion criteria, 72 (12.6%) presented with recurrence. The factors associated with recurrence after gross-total resection (Simpson I-III) were non-WHO grade 1 (HR [95 % CI] 6.215 [2.864-12.419], p < .0001) and preoperative neurological deficits (HR [95 % CI] 2.862 [1.512-5.499], p = 0.001). Factors associated with recurrence after subtotal resections (Simpson IV) were African-American patients (HR [95 % CI] 2.776 [1.232-5.890], p = 0.02) and parafalcine location (HR [95 % CI] 3.956 [1.624-8.775], p = 0.004). Notably, the Simpson grading scale was not an independent risk factor for recurrence. CONCLUSIONS The identification and consideration of the factors associated with recurrence after gross-total or subtotal resections may help guide treatment strategies for patients with meningiomas.