Date of Award
Management Practice in Nurse Anesthesia
Type of Degree
Alberto Coustasse, Committee Chair, Graduate College of Business, Marshall University
Cassy Taylor, Committee Member, CAMC School of Nurse Anesthesia
Robbie Lovejoy, Committee Member, CAMC Health System, Memorial Hospital
Abstract: The purpose of this study was to determine if there was an association between intraoperative blood glucose ≥150 mg/dl in patients undergoing an emergency craniotomy and Intensive Care Unit (ICU) Length of Stay (LOS), hospital LOS and mortality.
Introduction: Traumatic Brain Injuries (TBI)’s are associated with increased morbidity and mortality. The stress response by the body may cause an increase in blood glucose levels which can cause secondary brain injury. When a patient undergoes an emergency craniotomy following a TBI the increased stress on the body can cause an even higher blood glucose. There is no consensus in the literature as to what level is considered to be hyperglycemic, and there are also no definitive guidelines as to when treatment should be started for rising blood glucose levels. Many studies have found an association between preoperative hyperglycemia and poor postoperative outcomes and mortality, but few studies have looked at intraoperative blood glucose levels with postoperative outcomes and mortality.
Methodology: This study used a retrospective, quantitative, case control design at Charleston Area Medical Center in West Virginia. The chart review was conducted on adult patients who presented to the operating room for an emergency craniotomy following a TBI from January 1, 2005 through June 1, 2013. The sample was grouped by the first intraoperative blood glucose, the control group was <150 mg/dl (n=72), and the case group was ≥150 mg/dl (n=47). Patient characteristics of age, gender, Body Mass Index (BMI), mechanism of injury (penetrating or blunt), Injury Severity Score (ISS), intraoperative blood glucose, hospital LOS, ICU LOS, and mortality were collected. Means were compared using the Independent t-test for age, BMI, and ISS. Chi-square test was used to compare gender, ASA physical status, and mechanism of injury. With case control groups a logistic regression was used to determine a relationship between mortality with age, gender, BMI, ISS, mechanism of injury, and intraoperative hyperglycemia. Separate linear regressions analyzed ICU LOS and hospital LOS with age, gender, BMI, ISS, mechanism of injury, and intraoperative hyperglycemia.
Results: It was found statistically significant in the mean difference between the two groups (intraoperative blood glucose <150 mg/dl and ≥150 mg/dl) in percentage of mortality (5.6% and 21.3%). The mean age of the group was 36.8, mean days in the ICU was 8, mean ISS 28.4, mean days in the hospital 13.9, and mean BMI 26.4. Of the 119 patients, 96 (80.7%) were male, 23 (19.3%) were female, 110 (92.4%) had blunt injury type, 9 (7.6%) had penetrating injury type, and mortality rate was 14 (11.8%). The Odds Ratio showed that the case group was 4.6 times more likely to die compared to the control group which was statistical significant Statistical significance also was found with age and intraoperative glucose with mortality. ISS association with hospital LOS was shown to be statistically significant. No statistical significance was found between ICU LOS and intraoperative blood glucose.
Discussion: This study found that intraoperative blood glucose ≥150 mg/dl increased the rate of mortality by 4.6 times. Increased age was also shown to have an association with mortality. Increased hospital LOS was associated with ISS. ICU LOS was not shown to be associated with any of the variables tested. The literature has shown that higher glucose levels, age, and ISS have been associated with increase hospital LOS, ICU LOS, and mortality. Several study limitations were identified and discussed.
Conclusion: Intraoperative blood glucose ≥150 mg/dl was associated with a higher rate of mortality.
Implications/Recommendations: This study can be used as a guideline to practitioners to use ≥150 mg/dl as a definition for hyperglycemia in the intraoperative period in emergency craniotomy patients following a TBI to increase the rate of survival.
Anesthesiology -- Research.
Nursing -- Research.
Hoover, Sara Lynn, "Intraoperative Hyperglycemia in Adult Patients Undergoing an Emergency Craniotomy Following a Traumatic Brain Injury as a Predictor of Postoperative Outcomes and Mortality" (2013). Theses, Dissertations and Capstones. 1060.