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NCT Number: NCT07548112

Effects of Intensive Glycemic Control in the Postoperative Period of Neurosurgical Patients on the Incidence of Surgical Site Infection

Surgical site infections (SSIs) are frequent complications in neurosurgical patients, often worsened by perioperative hyperglycemia. This randomized, controlled trial will compare intensive glycemic control (continuous insulin infusion, 140-180 mg/dL) with standard care (subcutaneous insulin, 81-180 mg/dL) in 544 patients. The primary outcome is SSI occurrence within 90 days post-surgery. Results aim to guide optimal glycemic management for SSI prevention in neurosurgery.

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Key information

Conditions

Surgical Site Infection (SSI) Infections Pathologic Processes Pathological Conditions, Signs and Symptoms Postoperative Complications Surgical Wound Infection Wound Infection

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

About this study

Surgical site infections (SSIs) are common complications, contributing to increased morbidity, prolonged hospital stays, and higher healthcare costs. Neurosurgical patients are at an elevated risk of SSIs, particularly when exposed to perioperative hyperglycemia-a common condition due to the inflammatory response to surgical stress and corticosteroid use. However, there is still limited evidence regarding the effectiveness of intensive glycemic control in preventing these infections.

Objective: To investigate the impact of an intensive glycemic control regimen during the postoperative period, compared to the standard institutional protocol, on the occurrence of surgical site infections in patients undergoing neurosurgery.

Methods: This is a randomized, controlled, parallel clinical trial that will include patients undergoing neurosurgery, allocated into two groups: intensive glycemic control (continuous insulin infusion with a target of 140-180 mg/dL) and standard control (subcutaneous insulin correction with a target glycemic range of 81-180 mg/dL). The study will be conducted in a general SUS hospital, with 272 participants per group, assuming a 25% treatment effect, α = 5%, and 80% power. Randomization will be performed by an independent statistician, using a software-generated table, with 1:1 allocation in opaque, numbered, sealed envelopes. Only the statistician and the adjudication committee will remain blinded to the analyses. The primary outcome will be the occurrence of SSI up to the 90th day after the surgical procedure.

Expected Results: The findings are expected to provide evidence on the most effective interventions for neurosurgical patients regarding glycemic control and SSI prevention.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Adults aged ≥18 years
  • Patients undergoing elective cranial neurosurgical procedures classified as clean surgeries

Exclusion criteria

  • Patients who underwent any surgical or neurosurgical procedure within 30 days prior to enrollment
  • Presence of active infection at any site
  • Patients undergoing emergency or urgent neurosurgical procedures
  • Patients with trauma and exposed brain tissue
  • Diagnosis of diabetic ketoacidosis
  • Blood glucose levels >600 mg/dL

Treatment and study plan

Intensive glycemic control

Other

The interventions will be conducted in a structured and supervised manner to ensure safety, traceability, and risk management. Before data collection, the ICU multidisciplinary team-including nurses, technicians, physicians, and physiotherapists-will receive training on the study protocol, operational flows for glucose monitoring, inclusion/exclusion criteria, insulin preparation and administration, aseptic techniques, infection control, and complication management. Nurses will play a key role, monitoring patients, checking labs, and reporting adverse events. The lead researcher will provide continuous oversight, data review, and 24/7 support. Insulin will be administered via continuous IV infusion to maintain blood glucose between 140-180 mg/dL, following validated institutional protocols. Safety measures include hourly glucose checks, potassium monitoring, and interventions for hypo- or hyperglycemia. The protocol will be suspended if medically indicated, for patient transfer, or at

Hypokalemia Prevention Protocol During IV Insulin Therapy

Other

During intravenous insulin infusion, a hypokalemia prevention strategy will be implemented through the administration of a glucose solution combined with potassium chloride (KCl) and sodium chloride (NaCl), according to the current medical prescription. Insulin will only be initiated after confirmation of recent laboratory tests (≤24 hours) and serum potassium >3.5 mEq/L. In cases of hyperkalemia (≥5.0 mEq/L), potassium replacement will be withheld, maintaining insulin infusion with a glucose solution, with serum potassium reassessed after 2 hours. Serum potassium monitoring will be performed at protocol initiation, after 2 hours, and subsequently every 6 hours or as clinically indicated.

Glucose-Supported Intravenous Insulin Infusion Protocol

Other

Continuous intravenous insulin infusion will be initiated concomitantly with caloric support a glucose solution. The glucose concentration and infusion rate will be determined by the attending medical team according to each patient's clinical and metabolic status.

Primary outcomes

  1. primary outcome - surgical site infection

    Time frame: 90 days

    Incidence of surgical site infection (SSI) within 90 days after surgery, defined according to CDC (2024) criteria.

  2. Primary Outcome

    Time frame: 90 days

    Surgical site infections will be assessed during hospitalization through wound evaluation on alternate days, with photographic documentation. After discharge, follow-up will occur via telephone and outpatient visits. Suspected cases will be investigated with clinical assessment, cultures, and imaging when indicated. Diagnosis will follow CDC (2024) criteria and be reviewed by an adjudication committee.

Secondary outcomes

  1. Hypoglycemia

    Time frame: 90 days

    Number of participants with hypoglycemia (<70 mg/dL) within 90 days postoperatively.

    Assessment: Identified through capillary glucose measurements recorded in electronic medical records.

  2. Severe Hypoglycemia

    Time frame: 90 days

    Number of participants with severe hypoglycemia (<54 mg/dL) within 90 days postoperatively.

    Assessment: Recorded via capillary glucose measurements and clinical documentation.

  3. Hyperglycemia

    Time frame: 90 days

    Number of participants with hyperglycemia (>180 and <250 mg/dL) within 90 days postoperatively.

    Assessment: Based on capillary glucose measurements documented in medical records.

  4. Severe Hyperglycemia

    Time frame: 90 days

    Number of participants with severe hyperglycemia (≥250 mg/dL) within 90 days postoperatively.

    Assessment: Identified through glucose monitoring records.

  5. ICU Length of Stay

    Time frame: 90 days

    Length of postoperative ICU stay (in days), measured from ICU admission to discharge.

  6. Hospital Length of Stay

    Time frame: 90 days

    Total hospital length of stay (in days), measured from admission to hospital discharge.

  7. All-cause Mortality

    Time frame: 90 days

    All-cause mortality within 90 days after the procedure. Assessment: Verified through medical records, death certificates, and telephone follow-up if necessary.

Study contacts

Contact information is provided by the study sponsor or research team.

Alessandra Yuri Takehana de Andrade yuri Andrade, Lead Researcher

CONTACT

[email protected]

+5511987594903

Vanessa de Brito Poveda Poveda, Researcher

CONTACT

[email protected]

11997876690

Sponsors and collaborators

Lead sponsor

University of Sao Paulo

Other

Registry information

Acronym: Brain Sugar

Important dates

Study start
2026
Primary completion
2027
Study completion
2027
First posted
Apr 23, 2026
Registry last updated
Apr 23, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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