2026 Proffered Presentations
S245: PREOPERATIVE DIABETES AND POSTOPERATIVE OUTCOMES IN RESECTION OF CEREBRAL MENINGIOMAS: A MULTI-INSTITUTIONAL COHORT STUDY
Alexander Velasquez, BS1; Miguel Lopez-Gonzalez, MD2; 1UC Riverside School of Medicine; 2Loma Linda University Health: Department of Neurosurgery
Background: Meningiomas represent a substantial proportion of intracranial tumors, and despite their generally benign classification, surgical management remains associated with notable perioperative morbidity. Type 2 diabetes mellitus (T2DM) is a prevalent comorbidity in the United States that is associated with impaired vascular function, altered immune responses, and delayed wound healing, all of which may complicate postoperative recovery. Studies in other surgical specialties have suggested that patients with T2DM may be at increased risk of adverse postoperative outcomes. However, the specific impact of T2DM on cerebral meningioma resection has not been well defined. Clarifying this link can help surgeons better identify diabetic patients at higher risk and adjust perioperative management accordingly.
Methods: Using the TriNetX Global Research Network, a real-world database of de-identified electronic medical records, we identified adults (≥18 years) diagnosed with benign meningioma (ICD-10: D32.0) who underwent surgical excision on or after January 1, 2010. Included procedures encompassed supratentorial meningioma resection via craniotomy (CPT 61512), resection of infratentorial/posterior fossa meningioma (CPT 61510), and related meningioma-specific codes. Cohorts were defined according to the presence of a documented diagnosis of T2DM (ICD-10: E11) versus patients without any diabetes diagnosis. Patients with benign spinal neoplasms or malignant neoplasms of the meninges were excluded. Propensity score matching was performed using a 1:1 caliper approach, balancing cohorts on age at index, sex, hypertension (I10), overweight/obesity (E66), personal history of nicotine dependence (Z87.891), chronic ischemic heart disease (I25), active nicotine dependence (F17), chronic kidney disease (N18), and tobacco use (Z72.0). Complications were assessed within a 90-day postoperative window, including encephalopathy (metabolic, unspecified, and toxic subtypes), sepsis, cerebrospinal fluid (CSF) leakage, stroke, pneumonia, intracranial hemorrhage, poor wound healing, and myocardial infarction. All outcome analyses were conducted using built-in TriNetX analytics, which calculate risk ratios (RR) with corresponding 95% confidence intervals and p-values.
Results: After propensity score matching, each cohort comprised 2,871 patients, resulting in a total study population of 5,742. Within 90 days postoperatively, patients with T2DM demonstrated significantly higher rates of metabolic encephalopathy (1.22% vs 0.56%; RR 2.16; p = 0.0090), unspecified encephalopathy (3.70% vs 2.58%; RR 1.44; p = 0.0189), and sepsis (2.32% vs 1.03%; RR 2.25; p = 0.0002) compared to the non-diabetic cohort. No statistically significant differences were observed for CSF leakage, stroke, toxic encephalopathy, pneumonia, intracranial hemorrhage, poor wound healing, and myocardial infarction.
Conclusion: Preoperative T2DM is associated with increased risk of postoperative encephalopathy (metabolic and unspecified) and sepsis following cerebral meningioma resection. These findings highlight the importance of optimizing perioperative management in diabetic patients to mitigate adverse outcomes. Closer monitoring and individualized perioperative protocols could improve outcomes and reduce complications in diabetic patients undergoing meningioma surgery.