Risk factors for severe intraoperative hyperglycemia in patients undergoing elective neurosurgical surgery
OA Version
Citation
Abstract
INTRODUCTION: Severe intraoperative hyperglycemia (SIH) is defined as a blood glucose concentration above or equal to 180 mg/dL, and is associated with increased morbidity, including composite infections, leading to increased intensive care unit length of stay, hospital length of stay, and mortality. The pathophysiology of SIH is poorly understood but thought to be multifactorial, related to the catecholamine-releasing response to surgical stress and the body entering a catabolic state prior to surgery when traditional preoperative fasting guidelines are adhered to, amongst other factors. Previous studies have identified diabetes mellitus, elevated glycated hemoglobin (HbA1c), advanced age, increased body mass index (BMI), and steroid administration as risk factors for the development of SIH. The aim of this study was to determine the rate of SIH in patients undergoing elective intracranial procedures at Boston Medical Center in order to identify the common risk factors for SIH in this patient population. By identifying patients at risk for SIH before their procedure, medical care teams may be able to manage their blood glucose concentrations more tightly to avoid SIH and associated postoperative morbidity.
METHODS: This prospective observational study screened patients for eligibility before their scheduled surgery between May 2021 and October 2022. On the day of surgery when the eligible patients arrived at the preoperative area, they were approached and consented for this study. The inclusion criteria for this study were all patients who were scheduled for an elective intracranial procedure and were between ages 18 and 89. If patients had an emergency procedure, diagnosis of infection before surgery, were pregnant, or did not fit in the age range they were excluded. Patients who were enrolled had their charts reviewed, their intraoperative blood glucose levels were recorded three times during the procedure and daily for up to three days postoperatively, and the rate of SIH was recorded.
RESULTS: In total 44 patients were recruited for this study, but four of these patients were eliminated due to lacking intraoperative blood glucose measures. Out of the 40 patients who had the required three intraoperative blood glucose measures, four patients developed SIH. This made the rate of SIH 10%. SIH-positive patients’ mean age (SD) was 60 (9.99) years, and the mean age (SD) for SIH-negative patients was 51(16.69). There were no statistically significant findings for the predicted risk factors of SIH and there was no significant association between SIH and postoperative infections.
DISCUSSION: As previous studies have also found, the rate of SIH was low, with the cited rate for neurological procedures being 17%. It is possible that the low number of patients enrolled in this study was a result of low volume of intracranial procedures and inconsistent protocols for collecting blood glucose intraoperatively lowered the rate of SIH and led to no statistically significant findings. Nevertheless, the lack of statistical findings means none of the measured patient and intraoperative factors can be correlated to predicting the likelihood of SIH developing. Another possibility is treatment with insulin in some patients was working in preventing or treating SIH. Further research is needed to assess patient, surgical, and intraoperative factors for their potential as predicting factors for SIH to reduce SIH occurrences and improve patient outcomes.