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

    Final Number:

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

    Study Design:

    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.

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