Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Evidence-Based Medicine Center, Affiliated Hospital of Chengdu University, Chengdu, China.
Neurosurgery. 2024 Sep 1;95(3):682-691. doi: 10.1227/neu.0000000000002938. Epub 2024 Apr 18.
Hypoglycemia is a known risk of intensive postoperative glucose control in neurosurgical patients. However, the impact of postoperative hypoglycemia after craniotomy remains unexplored. This study aimed to determine the association between postoperative hypoglycemia and mortality in patients undergoing elective craniotomy.
This study involved adult patients who underwent elective craniotomy at the West China Hospital, Sichuan University, between January 2011 and March 2021. We defined moderate hypoglycemia as blood glucose levels below 3.9 mmol/L (70 mg/dL) and severe hypoglycemia as blood glucose levels below 2.2 mmol/L (40 mg/dL). The primary outcome was postoperative 90-day mortality.
This study involved 15 040 patients undergoing an elective craniotomy. Overall, 504 (3.4%) patients experienced moderate hypoglycemia, whereas 125 (0.8%) patients experienced severe hypoglycemia. Multivariable analysis revealed that both moderate hypoglycemia (adjusted odds ratio [aOR] 1.86, 95% CI 1.24-2.78) and severe (aOR 2.94, 95% CI 1.46-5.92) hypoglycemia were associated with increased 90-day mortality compared with patients without hypoglycemia. Moreover, patients with moderate (aOR 2.78, 95% CI 2.28-3.39) or severe (aOR 16.70, 95% CI 10.63-26.23) hypoglycemia demonstrated a significantly higher OR for major morbidity after adjustment, compared with those without hypoglycemia. Patients experiencing moderate (aOR 3.20, 95% CI 2.65-3.88) or severe (aOR 14.03, 95% CI 8.78-22.43) hypoglycemia had significantly longer hospital stays than those without hypoglycemia. The risk of mortality and morbidity showed a tendency to increase with the number of hypoglycemia episodes in patients undergoing elective craniotomy (P for trend = .01, <.001).
Among patients undergoing an elective craniotomy, moderate hypoglycemia and severe hypoglycemia are associated with increased mortality, major morbidity, and prolonged hospital stays. In addition, the risk of mortality and major morbidity increases with the number of hypoglycemia episodes.
低血糖是神经外科患者强化术后血糖控制的已知风险。然而，开颅术后低血糖的影响仍未被探索。本研究旨在确定择期开颅术后低血糖与患者死亡率之间的关系。
本研究纳入了 2011 年 1 月至 2021 年 3 月在四川大学华西医院接受择期开颅手术的成年患者。我们将中度低血糖定义为血糖水平低于 3.9mmol/L（70mg/dL），重度低血糖定义为血糖水平低于 2.2mmol/L（40mg/dL）。主要结局为术后 90 天死亡率。
本研究共纳入 15040 例行择期开颅手术的患者。总体而言，504 例（3.4%）患者发生中度低血糖，125 例（0.8%）患者发生重度低血糖。多变量分析显示，与无低血糖的患者相比，中度（调整优势比[OR]1.86，95%置信区间[CI]1.24-2.78）和重度（调整 OR 2.94，95% CI 1.46-5.92）低血糖均与 90 天死亡率增加相关。此外，与无低血糖的患者相比，中度（调整 OR 2.78，95% CI 2.28-3.39）或重度（调整 OR 16.70，95% CI 10.63-26.23）低血糖的患者在调整后主要发病率的 OR 更高。与无低血糖的患者相比，发生中度（调整 OR 3.20，95% CI 2.65-3.88）或重度（调整 OR 14.03，95% CI 8.78-22.43）低血糖的患者住院时间明显更长。在接受择期开颅手术的患者中，随着低血糖发作次数的增加，死亡率和发病率的风险呈上升趋势（趋势 P=.01，<.001）。
在接受择期开颅手术的患者中，中度低血糖和重度低血糖与死亡率增加、主要发病率增加和住院时间延长有关。此外，死亡率和主要发病率的风险随着低血糖发作次数的增加而增加。
