Stress hyperglycemia in general surgery: Why should we care?

Abstract

Aims: To determine the frequency of increasing levels of stress hyperglycemia and its associated complications in surgery patients without a history of diabetes.

Methods: We reviewed hospital outcomes in 1971 general surgery patients with documented preoperative normoglycemia [blood glucose (BG) <140mg/dL] who developed stress hyperglycemia (BG >140mg/dL or >180mg/dL) within 48h after surgery between 1/1/2010 and 10/31/2015.

Results: A total of 415 patients (21%) had ≥1 episode of BG between 140 and 180mg/dL and 206 patients (10.5%) had BG>180mg/dL. The median length of hospital stay (LOS) was 9days [interquartile range (IQR) 5,15] for BG between 140 and 180mg/dL and 12days (IQR 6,18) for BG>180mg/dL compared to normoglycemia at 6days (IQR 4,11), both p<0.001. Patients with BG 140-180mg/dL had higher rates of complications with an odds ratio (OR) of 1.68 [95% confidence interval (95% CI) 1.15-2.44], and those with BG>180mg/dL had more complications [OR 3.46 (95% CI 2.24-5.36)] and higher mortality [OR 6.56 (95% CI 2.12-20.27)] compared to normoglycemia.

Conclusion: Increasing levels of stress hyperglycemia are associated with higher rates of perioperative complications and hospital mortality in surgical patients without diabetes.

Keywords: General surgery; Hospital complications; Hospital hyperglycemia; Hospital mortality; Inpatient hyperglycemia; Stress hyperglycemia.

Conflict of interest statement

GD, MF, DRU, SH, JSH, LP, and SJ declared no conflicts of interest.

Copyright © 2017. Published by Elsevier Inc.

Figures

Fig. 1

(A) Frequency of post-operative hyperglycemia. The frequency of post-operative hyperglycemia to BG values > 140 mg/dL and percentage of values > 180 mg/dL increased within the first 72 h of surgery. (B) Length of hospital stay by postoperative blood glucose levels. The development of stress hyperglycemia significantly increased the hospital length of stay (LOS), with average hospital days increasing with the degree of hyperglycemia.

Fig. 2

Hospital complications by postoperative glucose values. Patients developing stress hyperglycemia, both to BG values 140–180 mg/dL and >180 mg/dL, had significantly higher frequency of stroke, pneumonia, acute respiratory failure and acute renal failure, as well as an overall higher occurrence of a composite of hospital complications.

Fig. 3

(A) Stress hyperglycemia and complications. Crude odds ratios (OR), and model adjusted for age, gender, BMI, race, and Charlson score for the association of stress hyperglycemia categories and composite of complications (acute MI, stroke, wound infection, pneumonia, UTI, sepsis, acute respiratory failure and acute renal failure). (B) Stress hyperglycemia and mortality. Crude odds ratios (OR), and model adjusted for age, gender, BMI, race, and Charlson score for the association of stress hyperglycemia categories with mortality.