Intraoperative Lactate Level as a Predictor of Resuscitation in Open Cranial Vault Reconstruction

Open cranial vault reconstructions (CVR) involve significant blood loss, and adequate resuscitation is crucial. Common metrics like heart rate (HR), mean arterial pressure (MAP), and urine output (UO) are ubiquitously used but are less sensitive than lactate levels for detecting cellular and tissue hypoxia. The purpose of this study is to evaluate whether physiological markers of resuscitation correlate with intraoperative lactate levels. A retrospective review of CVR patients at our institution (2013-2021) was conducted to collect intraoperative data including lactate AABLals. Among 148 patients with craniosynostosis (median age at surgery 1.3 y, IQR 0.8-3.2), 86.5% were non-syndromic, and 65.5% had no chronic health conditions. 17.6% of cases experienced at least one instance of elevated intraoperative lactate but showed no correlation with HR or MAP. Hyperlactatemia was associated with higher weight, lower preoperative hematocrit, and decreased UO. Each 1 kg increase in weight raised the odds of hyperlactatemia by 38% ( P =0.004). Conversely, each 1% increase in preoperative hematocrit reduced hyperlactatemia odds by 20% ( P =0.016). In addition, each 100 ml increase in UO reduced hyperlactatemia odds by 37% ( P =0.008). No correlation was identified between hyperlactatemia and postoperative complications. Intraoperative lactate levels do not directly correlate with conventional measures of hemodynamic stability. Hyperlactatemia was inversely correlated with UO and hematocrit, thus suggesting the importance of optimizing these parameters. On the basis of these findings, the authors caution against strict reliance on vitals for assessment of resuscitation during open CVR.