Perioperative Glucose Control in Neurosurgical Patients

Godoy, Daniel A.; Napoli, Mario Di; Biestro, Alberto; Lenhardt, Rainer

doi:10.1155/2012/690362

Cited by 19 publications

(22 citation statements)

References 94 publications

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“…8,9 However, the extent to which chronic opioid use independently influences surgical outcomes remains poorly understood. In this context, we sought to define the differences in healthcare utilization and associated costs among patients undergoing elective abdominal surgical procedures in the United States.…”

Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

et al. 2017

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Importance Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood. Objective To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. Design Truven Health Marketscan® Databases were used to identify patients. Setting Outpatient services claims from patients who underwent elective procedure requiring an inpatient stay. Participants Patients ages 18 and older who underwent elective hysterectomy, bariatric surgery, reflux procedures, and ventral hernia repair between 2009 and 2013 (n=184,053). Exposure Receipt of prescription opioid analgesic within 30 days of and 30 to 90 days prior to procedure. Preoperative opioid use was drawn from insurance claims and converted into oral morphine equivalents (OMEs). Main Outcomes and Measures Outcomes included postoperative healthcare utilization (length of stay, 30-day readmission rate, discharge destination) and cost (hospital stay, 90-, 180-, and 365-day). We used generalized linear regression to determine the effect of preoperative opioid use on healthcare utilization and cost outcomes after adjusting for number of comorbidities, psychological conditions, and demographic characteristics. Results In this cohort, 10.0% of patients used opioids preoperatively. Compared with non-users, patients using opioids preoperatively were more likely to have a longer and more expensive hospital stay (2.8 days vs. 2.5 days, p<0.001; $21,919.00 vs. $21,241.80, p = 0.02, respectively) and were more likely to be discharged to a rehabilitation facility (3.5% vs. 2.4%, p<0.001), adjusting for covariates. Preoperative opioid use was also correlated with a greater rate of 30-day readmission (3.7% vs. 3.1%, p<0.001) and overall greater expenditures at 90- ($5,405.40 vs. $3,681.70, p<0.001), 180- ($10,148.20 vs. $6,469.80, p<0.001), and 365-($19,695.60 vs. $11,419.40, p<0.001) days following surgery, adjusted for covariates. Conclusions and Relevance Preoperative opioid use is an independent risk factor for longer length of stay, higher 30-day readmission rates and probability of being discharged to a rehabilitation facility, and greater costs in the postoperative period. Preoperative interventions focused on opioid cessation and alternative analgesics may improve the safety and efficiency of elective surgery among chronic opioid users.

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Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

et al. 2017

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“…Clinical studies showed increased morbidity and mortality with hyperglycemia, after coronary artery bypass grafting (7-8). Diabetes is a well-known risk factor for postoperative infections (9), acute renal failure, ileus and prolonged hospital stay (10)(11). These data show the importance of perioperative blood glucose control in diabetes.…”

Section: Hyperglycemia and Perioperative Adverse Eventsmentioning

confidence: 92%

Perioperative Control of Blood Glucose

Kuşkonmaz

Arslan

2015

Med Sci and Discov

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This review mainly focuses on the management of type 2 diabetes in the preoperative setting with a special emphasis on intraoperative glycemic control. Some patients learn their diagnosis of diabetes just prior to the surgery. The prevalence of previously undiagnosed diabetes is reported to be 5.2-10% in literature. Treatment protocols must be tailored individually but evidence based approach in insulin administration and close monitoring of blood glucose are important in order to avoid both hyper and hypoglycemia

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“…Factors such as trauma, hemorrhage, ischemia, infection, surgery stress, anesthetic agents, critical illness and metabolic stress may lead to insulin resistance and B-cell dysfunction. These factors may cause the increase in blood glucose [12]. The stress of surgery may be the main factor.…”

Section: Fluctuations Of Blood Glucose During the Perioperative Periomentioning

confidence: 99%

“…Stress also evokes the development of insulin resistance, which can be caused by proinflammatory cytokines [13,14] and other factors such as some drugs. Stress-induced hyperglycemia may induce endothelial cell dysfunction, defects in immune function, aggravated oxidative stress, prothrombotic changes, cardiovascular effects, and specific brain area injury or a direct hypothalamic damage/irritation of glucose regulatory centers [12,[15][16][17]. Hyperglycemia has been shown to exasperate these deleterious effects.…”

Section: Fluctuations Of Blood Glucose During the Perioperative Periomentioning

confidence: 99%

“…Several studies have identified an association between diabetes and infectious complications after major spine surgery [34]. Patients with DM also have an increased frequency of complications, both major (e.g., wound infection, peripheral nerve root lesion, cardiac arrhythmia, acute renal failure, cerebrovascular accident) and minor (e.g., urinary tract infection, paralytic ileus, electrolyte deficiencies) [12].…”

Section: Impact Of Anaesthesia On Diabetes Neurosurgical Patientsmentioning

confidence: 99%

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Impact of Anesthesia on Systemic and Cerebral Glucose Metabolism in Diabetes Patients Undergoing Neurosurgery ?Updates of Diabetes and Neurosurgical Anesthesia?

Youtan¹

2013

J Diabetes Metab

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Accumulating evidences demonstrate that patients with diabetes have higher perioperative risk of complications and longer hospital stays than patients without diabetes. Intensive insulin therapy (IIT) may improve outcomes in hyperglycemic neurosurgical patients. However, currently there is no adequate data/evidence regarding optimal insulin delivery protocols and targeted blood glucose concentration during IIT. IIT continues to be explored as a therapeutic method to reduce morbidity associated with derangements in glucose metabolism. Hypoglycemia is a common side effect of IIT with the potential to result in significant morbidity, especially in patients undergoing neurosurgical surgery. Surgical stimulus is a potent cause which may affect patients stress response and influences the metabolic and endocrine system, which can lead to electrolyte imbalance and decrease of blood insulin level and subsequently result in impairment of immune response and increase of blood glucose level. The stress response can be prevented by sufficient Depth of anesthesia. So the Anesthesiologists play a very important role in manipulating the blood glucose of the diabetes patients during the neurosurgical operations. Narcotics affect systemic and cerebral metabolism, and studies indicate that most of anesthetics have restraining effects on brain oxygen and glucose consumption. In order to better regulate the blood glucose, the anesthesiologists should master the actions of every anesthetics. IIT is a double-edged sword; more investigations should be focused on optimising blood glucose level for euglycemia maintenance in the intraoperative management of diabetes neurosurgical patients.

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Perioperative Glucose Control in Neurosurgical Patients

Cited by 19 publications

References 94 publications

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

Perioperative Control of Blood Glucose

Impact of Anesthesia on Systemic and Cerebral Glucose Metabolism in Diabetes Patients Undergoing Neurosurgery ?Updates of Diabetes and Neurosurgical Anesthesia?

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