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Characterization of perioperative glycemic status and dexamethasone use with associated postoperative complications in glioblastoma patients

  • Original Article - Tumor - Glioma
  • Published:
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Abstract

Purpose

Postoperative morbidity in glioblastoma (GBM) patients can be due to the disease course but can also come from postoperative complications. Our objective was to study the association of dexamethasone use and perioperative hyperglycemia with postoperative complications in GBM patients.

Methods

A single-center, retrospective cohort study was conducted in patients who underwent surgery for primary GBM from 2014–2018. Patients with perioperative fasting blood glucose (FBG) measurements and adequate follow-up to assess for complications were included.

Results

A total of 199 patients were included. More than half (53%) had poor perioperative glycemic control (FBG ≥ 7 mM for ≥ 20% perioperative days). Higher dexamethasone dose (≥ 8 mg) was associated with higher FBG on postoperative days 2–4 and 5 (p = 0.02,0.05,0.004,0.02, respectively). Poor glycemic control was associated with increased odds of 30-day any complication and 30-day infection on univariate analysis (UVA), and 30-day any complication and increased length of stay (LOS) on multivariate analysis (MVA). Higher average perioperative daily dexamethasone dose was associated with increased odds of 30-day any complication and 30-day infection on MVA. Elevated hemoglobin A1c (HgbA1c, ≥ 6.5%) was associated with increased odds of 30-day any complication, 30-day infection, and LOS on UVA. In a multivariate linear regression model, only the diagnosis of diabetes mellitus predicted perioperative hyperglycemia.

Conclusions

Perioperative hyperglycemia, higher average dexamethasone use and elevated preoperative HgbA1c are associated with increased risk of postoperative complications in GBM patients. Avoiding hyperglycemia and limiting dexamethasone use in postoperative period may decrease the risk of complications. Select HgbA1c screening may allow the identification of a group of patients at higher risk of complications.

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Data Availability

Data available on request from the authors, contingent on approval from local ethics board.

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Acknowledgements

We would like to thank Dr. Kevin Petrecca, Dr. David Sinclair, and Dr. Abbas Sadikot for their comments. We also acknowledge Dr. Marie-Christine Guiot for assistance in identifying GBM patients from the neuropathology register. We also extend our gratitude to all the members of the healthcare team involved in brain tumor patient care at the MNH, including the neurosurgeons, nursing team, occupational therapists, physiotherapists, respiratory therapists and social workers.

Funding

This study recognizes funding from McGill University Health Centre Department of Neurosurgery Foundation, granted to Dr. Roberto Jose Diaz. All authors of this study have no relevant financial or non-financial interests to disclose.

Author information

Authors and Affiliations

  1. Faculty of Medicine, McGill University, Montreal, Canada

    Sukhdeep Jatana, Amro H. Mohammad, Tariq D. Al-Saadi, Mathew Carias, Cristina S. Mindru & Roberto Jose Diaz

  2. Department of Neurology and Neurosurgery, Montreal Neurological Institute - McGill University Health Centre, Montreal, Canada

    Tariq D. Al-Saadi, Cristina S. Mindru & Roberto Jose Diaz

  3. Department of Diagnostic Radiology, McGill University, Montreal, Canada

    Mathew Carias

  4. Neuro-Oncology Research Group, National Institute of Cancer, Bogotá, Colombia

    Natalia Guevara-Moriones & Miguel Angel Ruiz-Barrera

  5. Juan N. Corpas University Foundation, Bogotá, Colombia

    Natalia Guevara-Moriones

  6. Department of Neurosurgery, National Institute of Cancer, Bogotá, Colombia

    Miguel Angel Ruiz-Barrera

  7. Neurosurgical Oncology, Department of Neurology and Neurosurgery, Montreal Neurological Hospital - McGill University Health Centre, Montreal, Canada

    Roberto Jose Diaz

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  1. Sukhdeep Jatana
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Correspondence to Roberto Jose Diaz.

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Jatana, S., Mohammad, A.H., Al-Saadi, T.D. et al. Characterization of perioperative glycemic status and dexamethasone use with associated postoperative complications in glioblastoma patients. Acta Neurochir 165, 1031–1040 (2023). https://doi.org/10.1007/s00701-023-05541-6

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  • DOI: https://doi.org/10.1007/s00701-023-05541-6

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