Clinical impact of intraoperative hyperlactatemia during craniotomy

Abstract

ObjectPatients often develop markedly elevated serum lactate levels during craniotomy although the reason for this is not entirely understood. Elevated lactate levels have been associated with poor outcomes in critically ill septic shock patients, as well as patients undergoing abdominal and cardiac surgeries. We investigated whether elevated lactate in craniotomy patients is associated with neurologic complications (new neurological deficits) as well as systemic complications.MethodsWe performed a cohort study of elective craniotomy patients. Demographic and intraoperative data were collected, as well as three timed intraoperative arterial lactate values. Additional lactate, creatinine and troponin values were collected immediately postoperatively as well as 12 and 24 hours postoperatively. Assessment for neurologic deficit was performed at 6 hours and 2 weeks postoperatively. Hospital length-of-stay and 30-day mortality were collected.ResultsInterim analysis of 81 patients showed that no patient had postoperative myocardial infarction, renal failure, or mortality within 30 days of surgery. There was no difference in the incidence of new neurologic deficit in patients with or without elevated lactate (10/26, 38.5% vs. 15/55 27.3%, p = 0.31). Median length of stay was significantly longer in patients with elevated lactate (6.5 vs. 3 days, p = 0.003). Study enrollment was terminated early due to futility (futility index 0.16).ConclusionElevated intraoperative serum lactate was not associated with new postoperative neurologic deficits, other end organ events, or 30 day mortality. Serum lactate was related to longer hospital stay.

Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

“…15 This study showed that hyperlactatemia lengthens hospital stay. The results in the literature generally confirm this 16,17 unlike Lawton et al 18 This presented study had some strengths. Repeat lactate measurements were used instead of a single blood sample.…”

Factors affecting a persistent increase in the perioperative lactate levels in colorectal cancer surgery and its impact on postoperative outcomes

“…In the literature, studies are showing that there is a relationship between high lactate levels and prolonged stay in the hospital. 18,23 Some studies do not display this result. 13 In our study, the duration of hospitalization was significantly extended in patients with perioperative persistent lactate height.…”

Association between Intraoperative Hyperlactatemia and Myocardial Injury after Noncardiac Surgery

“…Thus, the influence of the intraoperative status could not be assessed. Several studies have evaluated mortality or other postoperative complications associated with elevated lactate levels in various surgeries [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ], but the association has never been evaluated specifically between intraoperative lactate levels and MINS, which share a common mechanism-related oxygen demand and supply mismatch. We demonstrated that patients with intraoperative hyperlactatemia had an increased risk of MINS.…”