Division of Hospital Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
J Diabetes Sci Technol. 2024 May;18(3):556-561. doi: 10.1177/19322968241232695. Epub 2024 Feb 26.
Postoperative hospital length of stay (LOS) is longer in patients with diabetes than in patients without diabetes. Stress hyperglycemia (SH) in patients without a history of diabetes has been associated with adverse postoperative outcomes. The effect of SH on postoperative LOS is uncertain. The aim of this study is to compare postoperative LOS in patients with SH to patients with diabetic hyperglycemia (DH) following noncardiac surgery.
We carried out a retrospective cohort study of inpatients with at least two glucose measurements ≥180 mg/dL. Two groups were compared. Patients with SH had no preoperative history of diabetes. Patients were considered to have DH if they had an established preoperative diagnosis of diabetes mellitus or a preoperative hemoglobin A1c (HbA1c) ≥6.5%. The primary outcome measure was hospital LOS.
We included 270 patients with postoperative hyperglycemia-82 in the SH group and 188 in the DH group. In a linear regression analysis, hospital LOS was longer in the SH group than in the DH group (10.4 vs 7.3 days; = .03). Within the SH group, we found no association between LOS and prompt treatment of hyperglycemia within 12 hours ( = .43), insulin dose per day ( = .89), or overall mean glucose ( = .13).
Postoperative LOS was even longer in patients with SH than in patients with DH, representing a potential target for quality improvement efforts. We did not, however, find evidence that improved treatment of SH was associated with reduction in LOS.
患有糖尿病的患者术后住院时间（LOS）比没有糖尿病的患者长。既往无糖尿病史的应激性高血糖（SH）与术后不良结局相关。SH 对术后 LOS 的影响尚不确定。本研究旨在比较非心脏手术后并发 SH 与并发糖尿病高血糖（DH）患者的术后 LOS。
我们对至少有两次血糖测量值≥180mg/dL 的住院患者进行了回顾性队列研究。比较了两组患者。SH 组患者无术前糖尿病史。如果患者有明确的糖尿病诊断或术前糖化血红蛋白（HbA1c）≥6.5%，则认为其患有 DH。主要观察指标为住院 LOS。
我们纳入了 270 例术后高血糖患者，其中 82 例为 SH 组，188 例为 DH 组。线性回归分析显示，SH 组的 LOS 长于 DH 组（10.4 天比 7.3 天；P=0.03）。在 SH 组中，我们发现 12 小时内及时治疗高血糖（P=0.43）、胰岛素日剂量（P=0.89）或总体平均血糖（P=0.13）与 LOS 之间均无关联。
与 DH 患者相比，SH 患者的术后 LOS 甚至更长，这代表了质量改进努力的潜在目标。但是，我们没有发现改善 SH 治疗与降低 LOS 之间存在关联的证据。
