Persistent postoperative hyperglycemia tied to increased risk of mortality in patients undergoing elective craniotomy: Study

The impact of persistent postoperative hyperglycemia after craniotomy has not been explored yet. Considering this, Jialing He, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, and colleagues aimed to investigate the hypothesis that persistent postoperative hyperglycemia is associated with mortality in patients undergoing an elective craniotomy.

Adult patients (age ≥ 18 years) undergoing an elective craniotomy between 2011 and 2021 at the West China Hospital, Sichuan University, were included in the study. Peak daily blood glucose values measured within the first seven days following craniotomy were collected.

Persistent hyperglycemia was defined by two or more consecutive serum glucose levels of mild, moderate, or severe hyperglycemia. Severe hyperglycemia, moderate hyperglycemia, mild hyperglycemia, and normoglycemia were defined as glucose values of > 10.0 mmol/L, > 7.8 and ≤ 10.0 mmol/L, 6.1 and ≤ 7.8 mmol/L, and ≤ 6.1 mmol/L, respectively.

A total of 14,907 patients undergoing an elective craniotomy were included. The study led to the following findings:

• In the multivariable analysis, moderate (adjusted OR 3.76) and severe (adjusted OR 3.82) persistent hyperglycemia in patients were associated with higher 30-day mortality compared with normoglycemia. However, this association was not observed in patients with mild hyperglycemia (adjusted OR 1.32).
• The association was observed regardless of whether patients had preoperative hyperglycemia.
• There was no interaction between moderate or severe hyperglycemia and preexisting diabetes.
• When postoperative peak blood glucose values within the first 7 days after craniotomy were evaluated as a continuous variable, for each 1-mmol/L increase in blood glucose, the adjusted OR of 30-day mortality was 1.17.
• Postoperative blood glucose (area under the curve [AUC] = 0.78) was superior to preoperative blood glucose (AUC = 0.65) for predicting mortality.
• Moderate and severe persistent hyperglycemia in patients was associated with an increased risk of deep venous thrombosis (adjusted OR 3.20), myocardial infarction (adjusted OR 4.38), pneumonia (adjusted OR 2.77), and prolonged hospital stays (adjusted OR 1.43).

In conclusion, the study assessed the association of persistent postoperative hyperglycemia with mortality after elective craniotomy. The results showed that in this population, moderate and severe persistent postoperative hyperglycemia were associated with an increased risk of mortality compared with normoglycemia, irrespective of preoperative hyperglycemia.

Reference:

He, Jialing, et al. "Association of Persistent Postoperative Hyperglycemia With Mortality After Elective Craniotomy." Journal of Neurosurgery, vol. 140, no. 4, 2024, pp. 1080-1090.