In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Inpatient Post-Operative Hyperglycemia in Patients With Malignant Glioma Correlates With Increased Post-Operative Complications, and 30-Day Readmission or Mortality

    Final Number:
    694

    Authors:
    Matthew Decker; Maryam Rahman MD MS; Edward De Leo BS; Joseph Abbatematteo Pharm D

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Expert opinion on inpatient blood glucose (BG) control recommend critically ill patients maintain 140-180 mg/dL and non-critical patients have premeal BG value <140 mg/dL. Inpatient hyperglycemia is correlated with high morbidity and mortality in ischemic stroke, aneurysmal subarachnoid hemorrhage and traumatic brain injury populations. Limited studies assessing inpatient hyperglycemia in malignant glioma patients after undergoing craniotomy for resection. This study’s aim is to assess if a correlation between complications and 30-day readmission/mortality exists in post-operative malignant glioma patients who are on corticosteroids

    Methods: A retrospective review was performed of malignant glioma (WHO Grade III or IV) patients undergoing craniotomy for resection and on corticosteroids post-operatively. Demographics, morbidities, presenting symptoms, pre-operative MRI enhancing volume and post-operative steroid use were obtained. Pre-surgical BG values and BG values for post-operative day (POD) 0, 1, and 2 were recorded. Post-operative complications including seizure, wound infection, urinary tract infection, pneumonia, sepsis, wound dehiscence, DVT/PE, and a readmission or mortality within 30-days of discharge were recorded. A ROC curve of average POD 0-2 BG values assessing total morbidity as well as readmission/mortality were performed to determine BG value of significance. A stepwise logistic regression assessing pre-operative findings and BG value of significance was performed for post-operative complications and readmission/mortality.

    Results: One-hundred and four patients within a four-year period underwent open craniotomy for malignant glioma resection and were placed on corticosteroids post-operatively. Mean BG values were significant for increased morbidity and readmission/mortality. A mean BG over 167 mg/dL was a significant independent factor for increased complication rate (OR 11.38) and for increased 30-day readmission or mortality (OR 20.40).

    Conclusions: Patients with malignant gliomas placed on corticosteroid therapy for symptom or cerebral edema control have elevated BG values. Mean BG values >167 mg/dL in the immediate post-operative period correlates with increased complication and readmission/mortality rate. Basal-bolus approach could obtain better control.

    Patient Care: It highlights an area of patient care that practitioners may not fully realize contributes to a patient's overall prognosis by identifying a non-oncological or neurological contributor towards lower quality of life

    Learning Objectives: At the end of the conclusion, participants should be able to: 1) highlight previous work assessing hyperglycemia in post-operative malignant glioma patients, 2) highlight the significant findings associated with the study, 3) learn a better method for blood glucose control, 4) apply concepts learned to their own clinical decision making in their practice.

    References: 1: "Standards of Medical Care in Diabetes--2012." Diabetes Care 35.1 (2012): S11-63. Print. 2: Wexler, D. J., J. B. Meigs, E. Cagliero, D. M. Nathan, and R. W. Grant. "Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes: A National Survey of 44 U.S. Hospitals." Diabetes Care (2007): 367-69. Print. 3: Umpierrez, G. E. "Hyperglycemia: An Independent Marker of In-Hospital Mortality in Patients with Undiagnosed Diabetes." Journal of Clinical Endocrinology & Metabolism (2002): 978-82. Print. 4: Zerr, Mba Kathryn J, Md Anthony P Furnary, Phd Gary L Grunkemeier, Md Stephen Bookin, Md Vivek Kanhere, and Md Albert Starr. "Glucose Control Lowers the Risk of Wound Infection in Diabetics After Open Heart Operations." The Annals of Thoracic Surgery (1997): 356-61. Print. 5: "2015 Accountability Measure List for Accreditation." 2015 Accountability Measure List for Accreditation. The Joint Commission, 1 Sept. 2015. Web. 6 Jan. 2016. <http://www.jointcommission.org/assets/1/18/ACCOUNTABILITYMEASURES_2015_September_2015.pdf>. 6: "NQF-Endorsed Voluntary Consensus Standards For Hospital Care." Cardiac Surgery Patients with Controlled Postoperative Blood Glucose. The Joint Commission, 2014. Web. 19 Jan. 2016. <http://www.jointcommission.org/assets/1/6/2w_SCIP-Inf-4.pdf>. 7: Weir, C. J, G. D Murray, A. G Dyker, and K. R Lees. "Is Hyperglycaemia an Independent Predictor of Poor Outcome after Acute Stroke? Results of a Long Term Follow up Study." Bmj (1997): 1303. Print. 8: Lindsberg, P. J. "Hyperglycemia in Acute Stroke." Stroke 35 (2004): 363-64. Print. 9: Baird, T. A., M. W. Parsons, T. Phan, K. S. Butcher, P. M. Desmond, B. M. Tress, P. G. Colman, B. R. Chambers, and S. M. Davis. "Persistent Poststroke Hyperglycemia Is Independently Associated With Infarct Expansion and Worse Clinical Outcome." Stroke 34 (2003): 2208-214. Print. 10: Badjatia, Neeraj, Mehmet A. Topcuoglu, Ferdinando S. Buonanno, Eric E. Smith, Raul G. Nogueira, Guy A. Rordorf, Bob S. Carter, Christopher S. Ogilvy, and Aneesh B. Singhal. "Relationship between Hyperglycemia and Symptomatic Vasospasm after Subarachnoid Hemorrhage*." Critical Care Medicine 33.7 (2005): 1603-609. Print. 11: Frontera, J. A., A. Fernandez, J. Claassen, M. Schmidt, H. C. Schumacher, K. Wartenberg, R. Temes, A. Parra, N. D. Ostapkovich, and S. A. Mayer. "Hyperglycemia After SAH: Predictors, Associated Complications, and Impact on Outcome." Stroke (2005): 199-203. Print. 12: Kruyt, N D, Y W B M Roos, S M Dorhout Mees, W M Van Den Bergh, A. Algra, G J E Rinkel, and G J Biessels. "High Mean Fasting Glucose Levels Independently Predict Poor Outcome and Delayed Cerebral Ischaemia after Aneurysmal Subarachnoid Haemorrhage." Journal of Neurology, Neurosurgery & Psychiatry (2008): 1382-385. Print. 13: Smith, Rebecca L., John C. Lin, P. David Adelson, Patrick M. Kochanek, Ericka L. Fink, Stephen R. Wisniewski, Hülya Bayir, Elizabeth C. Tyler-Kabara, Robert S. B. Clark, S. Danielle Brown, and Michael J. Bell. "Relationship between Hyperglycemia and Outcome in Children with Severe Traumatic Brain Injury." Pediatric Critical Care Medicine (2012): 85-91. Print. 14: Rovlias, Aristedis, and Serafim Kotsou. "The Influence of Hyperglycemia on Neurological Outcome in Patients with Severe Head Injury." Neurosurgery (1999): 335. Print. 15: Parejo, Pedro, Nils Stahl, Wangbin Xu, Peter Reinstrup, Urban Ungerstedt, and Carl Nordstrom. "Cerebral Energy Metabolism during Transient Hyperglycemia in Patients with Severe Brain Injury." Intensive Care Medicine 29 (2003): 544-50. Print. 16: Stupp, R., J.- C. Tonn, M. Brada, and G. Pentheroudakis. "High-grade Malignant Glioma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up." Annals of Oncology (2010): V190-193. Print. 17: Omuro, Antonio. "Glioblastoma and Other Malignant Gliomas." JAMA (2013): 1842. Print. 18: Hempen, Christina, Elisabeth Weiss, and Clemens F. Hess. "Dexamethasone Treatment in Patients with Brain Metastases and Primary Brain Tumors: Do the Benefits Outweigh the Side-effects?" Support Care Cancer Supportive Care in Cancer (2002): 322-28. Print. 19: Iwamoto, Takuya, Yoshiyuki Kagawa, Yutaka Naito, Shigeki Kuzuhara, and Michio Kojima. "Steroid-Induced Diabetes Mellitus and Related Risk Factors in Patients with Neurologic Diseases." Pharmacotherapy (2004): 508-14. Print. 20: Link, Thomas W., Graeme F. Woodworth, Kaisorn L. Chaichana, Stuart A. Grossman, Robert S. Mayer, Henry Brem, Jon D. Weingart, and Alfredo Quinones-Hinojosa. "Hyperglycemia Is Independently Associated with Post-operative Function Loss in Patients with Primary Eloquent Glioblastoma." Journal of Clinical Neuroscience: 996-1000. Print. 21: Chambless, Lola B., Scott L. Parker, Laila Hassam-Malani, Matthew J. Mcgirt, and Reid C. Thompson. "Type 2 Diabetes Mellitus and Obesity Are Independent Risk Factors for Poor Outcome in Patients with High-grade Glioma." J Neurooncol Journal of Neuro-Oncology (2011): 383-89. Print. 22: Mcgirt, Matthew J., Kaisorn L. Chaichana, Muraya Gathinji, Frank Attenello, Khoi Than, Amado Jimenez Ruiz, Alessandro Olivi, and Alfredo Quiñones-Hinojosa. "Persistent Outpatient Hyperglycemia Is Independently Associated With Decreased Survival After Primary Resection Of Malignant Brain Astrocytomas." Neurosurgery (2008): 286-91. Print. 23: Derr, R. L., X. Ye, M. U. Islas, S. Desideri, C. D. Saudek, and S. A. Grossman. "Association Between Hyperglycemia and Survival in Patients With Newly Diagnosed Glioblastoma." Journal of Clinical Oncology (2009): 1082-086. Print. 24: Sawin, Gregory, and Allen Shaughnessy. "Glucose Control in Hospitalized Patients." American Family Physician 81.9 (2010): 1121-124. Print.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy