Hyperglycemia in Neurosurgery
Condition: Hyperglycemia; Postoperative Infection
MeSH terms: Infections; Hyperglycemia
Study type: Observational

Summary: 
      Poor glycemic control is recognized as a risk factor for postoperative infection. For the
      neurosurgical patient, postoperative infection can lead to devastating complications such as
      meningitis, encephalitis and death. Neurosurgical patients often receive high doses of
      medications that increase blood glucose levels such as steroids, placing them at a
      potentially higher risk for postoperative infection. The purpose of this multisite
      observational study is to assess the impact of severe intraoperative hyperglycemia as a risk
      factor for postoperative infection in the neurosurgical patient.
    

Detailed description: 
      This is a multisite [3 locations] prospective observational study of adult patients (18-89
      years old) scheduled for elective intracranial (open or endoscopic) procedures that require
      general anesthesia and a hospital stay of at least 1 day after the surgery. All sites will
      follow the standard of care clinical protocol for glycemic management that was developed at
      Boston Medical Center (BMC). Laboratory tests will be collected at the discretion of the
      primary clinician. This observational study does not require any change to routine clinical
      practice.

      The following perioperative data (timeframe between Pre-Procedure Clinic visit through
      Post-Anesthesia Care Unit discharge): blood glucose measurements, total insulin dose, total
      dexamethasone dose, estimated intraoperative blood loss, antibiotic prophylaxis regimen.

      The patient's electronic medical records data will be reviewed 7 days after the neurosurgical
      procedure to abstract all available culture data (blood, urine, sputum, CSF), available
      treatment regimen data prescribed for infection (antibiotics), complications from
      hyperglycemia (diabetic ketoacidosis, hyperglycemic nonketotic coma) or insulin therapy
      (hypoglycemia episodes). Intensive care unit (ICU) and hospital length of stay will also be
      obtained form the medical records.

      The investigators anticipate finding four groups of patients with regards to intraoperative
      blood glucose levels and management: 1) patients with no episodes of severe intraoperative
      hyperglycemia, 2) patients with intraoperative hyperglycemia who received insulin treatment,
      3) patients with intraoperative hyperglycemia who did not receive insulin treatment and 4)
      patients with no available laboratory data.
    

Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Adult patients (18-89 years at the time of surgery) scheduled for elective intracranial
        (open surgical or endoscopic) intervention and require general anesthesia and a hospital
        stay of at least 1 day post-procedure.
      
Keywords: Intraoperative hyperglycemia; Postoperative infection; Neurosurgical patient; Open surgical intracranial intervention; Endoscopic intracranial intervention