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Association of persistent postoperative hyperglycemia with mortality after elective craniotomy
Jialing He1, Yu Zhang2, Lu Jia3
11Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan.
Journal of Neurosurgery
|April 2, 2024
Summary
Persistent moderate and severe hyperglycemia after craniotomy significantly increases 30-day mortality risk. This association holds true even for patients with pre-existing diabetes or preoperative hyperglycemia, highlighting the importance of blood glucose control post-surgery.
Area of Science:
- Neurosurgery
- Endocrinology
- Critical Care Medicine
Background:
- Persistent postoperative hyperglycemia following craniotomy is an understudied area.
- Elevated blood glucose levels post-surgery may impact patient outcomes.
Purpose of the Study:
- To investigate the association between persistent postoperative hyperglycemia and mortality in patients undergoing elective craniotomy.
- To determine if the severity of hyperglycemia influences mortality risk.
Main Methods:
- A cohort study of 14,907 adult patients undergoing elective craniotomy between 2011 and 2021.
- Persistent hyperglycemia defined by ≥2 consecutive elevated serum glucose levels within 7 days post-craniotomy.
- Blood glucose levels categorized into normoglycemia, mild, moderate, and severe hyperglycemia.
Main Results:
- Moderate and severe persistent hyperglycemia were linked to significantly higher 30-day mortality (aOR 3.76 and 3.82, respectively).
- Mild hyperglycemia did not show a significant association with mortality.
- Postoperative blood glucose levels were superior predictors of mortality compared to preoperative levels (AUC 0.78 vs. 0.65).
- Hyperglycemia also increased risks of DVT, pneumonia, myocardial infarction, and prolonged hospital stays.
Conclusions:
- Moderate and severe persistent hyperglycemia post-craniotomy are independent risk factors for increased 30-day mortality.
- The association between hyperglycemia and mortality is observed irrespective of preoperative glucose status or pre-existing diabetes.
- Effective postoperative glucose management is crucial for improving outcomes in craniotomy patients.
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