Association Between Postoperative Hyperglycemia and Mortality in Pediatric Elective Craniotomy

INTRODUCTION: Hyperglycemia is a prevalent condition among pediatric neurosurgical patients. However, the impact of postoperative hyperglycemia after pediatric craniotomy remains unexplored. This study aimed to determine the association between postoperative hyperglycemia and mortality in children undergoing elective craniotomy. METHODS: This was a retrospective, single-center study involving pediatric patients who underwent elective craniotomy. We used multivariable regression to adjust for potential confounders and identify associations between postoperative hyperglycemia and mortality. We defined mild hyperglycemia as 8.3 to 11.1 mmol/L (150 to 200 mg/dL) and severe hyperglycemia as 11.1 mmol/L (200 mg/dL) or higher. The primary outcome was postoperative 90-day mortality. Secondary outcomes included 30-day mortality, composite morbidity, and prolonged hospital stay. RESULTS: This study involved 1309 children undergoing elective craniotomy. Overall, 198 (15.1%) patients experienced mild hyperglycemia, whereas 125 (6.0%) patients experienced severe hyperglycemia. The overall 90-day mortality rate was 6.8% (n=89). Mortality was 5.0% in the normoglycemia group, 9.1% in the mild hyperglycemia group, and 24.1% in the severe hyperglycemia group. Severe hyperglycemia (aOR 3.65, 95% CI: 1.82-7.35) was associated with increased 90-day mortality, while mild hyperglycemia showed no association (aOR 1.84, 95% CI: 1.00-3.40). Similarly, severe hyperglycemia was associated with greater morbidity and prolonged hospital stays. In subgroup analysis, no association was observed in children younger than 5 years (aOR 1.19, 95% CI: 0.49-2.89). CONCLUSION: Among children undergoing elective craniotomy, severe hyperglycemia was associated with increased mortality.