Perioperative hyperlactataemia in paediatric patients after elective tumour craniotomy

Perioperative hyperlactataemia is common in patients undergoing craniotomy. We assessed the frequency, clinical factors and association of hyperlactataemia with intensive care unit length of stay, morbidity and mortality in children. This retrospective, monocentric cohort study analysed perioperative data of 144 children undergoing 168 craniotomies between 2013 and 2022. The study population was divided in a normal (< 2 mmol/L) and high (≥ 2 mmol/L) lactate group. We compared the groups regarding demographics, perioperative characteristics, tumour characteristics and outcome. Perioperative hyperlactataemia was reported in 77 (46%) tumour craniotomies, with the majority of elevated values (72/77, 93%) between 2 and < 5 mmol/l. The high lactate group had higher blood glucose levels on admission (median 6.2 mmol/l [IQR 5.4, 7.2] versus median 5.7 mmol/l [IQR 4.8, 6.5]; p < 0.001) and received a higher perioperative steroid dose than the normal lactate group (median 0.21 mg/kg body weight (BW) [IQR 0.07, 0.31] versus median 0.11 mg/kg BW; [IQR 0, 0.31]; p = 0.047). Tumour characteristics, perioperative factors such as fluids, transfusions, vasoactive requirement or duration of surgery, length of stay and mortality did not differ between the two groups. Lactate levels in high-grade tumour patients were higher on admission compared to other tumour types. Moderate hyperlactataemia is common in children after neurosurgical intervention for tumour resection. This may be attributed to the tumour itself, perioperative steroids and hyperglycaemia. In the absence of any clinical signs of hypoperfusion, clinicians should carefully consider whether moderate hyperlactataemia warrants interventions such as fluid resuscitation, transfusion or prolonged monitoring.