title: Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery.
abstract: OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated with higher blood glucose levels upon admission to the ICU and higher peak blood glucose on the first postoperative day.
authors.affiliation: Departments of 1 Anesthesiology and.|Department of Anesthesiology, Hospital Universitário Professor Edgar Santos, Salvador, Bahia;
authors.forename: Nazel Oliveira
authors.initials: NO
authors.lastname: Filho
authors.affiliation: Departments of 1 Anesthesiology and.|Department of Anesthesiology, Hospital Universitário Professor Edgar Santos, Salvador, Bahia;
authors.forename: Rodrigo L
authors.initials: RL
authors.lastname: Alves
authors.affiliation: Departments of 1 Anesthesiology and.
authors.forename: Adriano T
authors.initials: AT
authors.lastname: Fernandes
authors.affiliation: Hospital Barra Dor, Rio de Janeiro;
authors.forename: Fernanda S P
authors.initials: FS
authors.lastname: Castro
authors.affiliation: Pediatric Neurosurgery, Hospital São Rafael;|Hospital Universitário Professor Edgar Santos, Salvador, Bahia; and.
authors.forename: José Roberto Tude
authors.initials: JR
authors.lastname: Melo
authors.affiliation: Department of Anesthesiology, Faculdade Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.
authors.forename: Norma S P
authors.initials: NS
authors.lastname: Módolo
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D001938:Brazil / Q000453:epidemiology; D016543:Central Nervous System Neoplasms / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D019635:Neurosurgical Procedures; D016017:Odds Ratio; D010343:Patient Admission; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose
keywords: ICU = intensive care unit; central nervous system tumors; hyperglycemia; morbidity; neurosurgery; outcome; pediatric