Hyperlactatemia After Intracranial Tumor Surgery Does Not Affect 6-Month Survival: A Retrospective Case Series

Abstract

Background: Patients undergoing neurosurgery frequently exhibit hyperlactatemia. The aim of this study was to identify factors associated with hyperlactatemia and assess how hyperlactatemia impacts survival and hospital length of stay after intracranial tumor surgery. Materials and Methods: This retrospective cohort study included 496 adult patients that underwent surgery between January 1, 2014 and December 31, 2015. We evaluated patient characteristics, surgery characteristics, pH, lactate, and blood glucose from blood samples collected on admission to the high-dependency unit and the morning after surgery, and 6-month outcome data. Results: Hyperlactatemia (>2.0 mmol/L) occurred in >50% of patients, but only 7.7% had acidosis. Postoperative hyperlactatemia was not correlated with 6-month survival (P=0.987), but was correlated with (median [interquartile range]) longer hospital stays (6 [4 to 8.5] d vs. 5 [4 to 8] d; P=0.006), longer surgery duration (4:53 [4:01 to 6:18] h:min vs. 4:28 [3:33 to 5:53] h:min; P=0.001), higher dexamethasone dose (16 [16 to 35] mg vs. 16 [16 to 20] mg; P<0.001), and higher blood glucose concentration (8.4 [7.5 to 9.6] mmol/L vs. 8.0 [7.1 to 8.9] mmol/L; P<0.001). Patients that received total intravenous anesthesia developed hyperlactatemia less frequently than those that received balanced anesthesia with inhalational agents (48.4% vs. 61.5%, P=0.008). Hyperlactatemia was not associated with increased postoperative neurological deficits or the need for rehabilitation therapy. Conclusions: Hyperlactatemia was common after intracranial tumor surgery. It did not influence 6-month outcomes but was associated with longer hospital length of stay. Several potential causative factors for hyperlactatemia were identified.

Factors affecting serum lactate in patients with intracranial tumors – A report of our series and review of the literature

“…e research was conducted up to April 2019 and yielded 215 studies. e articles [1][2][3]5,9,14] in which the correlation between the level of serum lactate and intracranial tumors was studied are reported in Table 4. In an initial series of 18 patients submitted to craniotomy for intracranial tumor, the authors found an increase of serum lactate during surgery regardless to the diagnosis.…”

“…is is an important topic to address in future although the previous studies failed to demonstrate a correlation between increased serum lactate and patient's prognosis. [2,3,14]…”

“…28-meningioma 37-pituitary 17-metastasis 39-other (non-glial cell tumors) Shih et al, 2017 [14] 74 20-HGG 54-LGG Cata et al, 2017 [2] 275 275-GBM de Smalen et al, 2019 [3] 496…”

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

“…17,24 In a few studies, similar to our results, the effect of persistent high lactate levels on survival has not been demonstrated. 6,25 One of the strengths of the study is that the research included repetitive measurements in lactate measurement instead of just a single blood sample. The lactate values measured before completion of the surgery were supported by four following measures in the early postoperative period, and the relationship between different variables and persistent elevations was investigated.…”

Hyperlactatemia in children following brain tumor resection: prevalence, associated factors, and clinical significance

“…However, an overlap frequently occurs between the two types [1,7,8]. A high prevalence of hyperlactatemia has been shown during and after craniotomy for brain tumor resection among adults [9][10][11]. The clinical significance of hyperlactatemia in this setting is unclear.…”