Stress hyperglycemia in general surgery: Why should we care?
Open accessAbstract
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.
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Therapeutic strategies can reduce glucose swings and prevent hypoglycemia.
“Therapeutic approaches can minimize glycemic excursions and prevent hypoglycemia.1243–1247”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1247]
The Discussion (page not provided) reports that lower glucose targets improved complications in certain patients with stress hyperglycemia. It does not say therapeutic approaches minimize glycemic excursions or prevent hypoglycemia; searches for hypoglycemia, glycemic excursions, and glucose variability found no passage establishing either effect. (LLM, conf=0.75)
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References 27 · Cited by 80
- Authors
- Davis, G., Fayfman, M., Reyes-Umpierrez, D., Hafeez, S., Pasquel, F. J., Vellanki, P., Haw, J. S., Peng, L., Jacobs, S., & Umpierrez, G. E.
- Affiliations
- Emory University (US)
- Corresponding author
- Umpierrez, Guillermo E.
- ORCID
- Venue
- Journal of Diabetes and its Complications
- Publisher
- Elsevier BV
- Published
- 2018-03
- Volume
- 32
- Issue
- 3
- Pages
- 305-309
- ISSN
- 0891-6632 (ISSN-L)
- 1056-8727
- PMC
- PMC5975368
- OpenAlex
- W2770349711
- Cited by
- 80
- References
- 27
- Citations by year
- 2026: 10 · 2025: 14 · 2024: 16 · 2023: 6 · 2022: 10 · 2021: 6 · 2020: 6 · 2019: 7 · 2018: 5
- FWCI
- 3.87
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Diabetes and its Complications (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Jacobs Family Research Fund
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- stress hyperglycemia, general surgery, perioperative complications, postoperative mortality, length of hospital stay, blood glucose
- MeSH terms
- Aged, Blood Glucose, Female, Humans, Hyperglycemia, Length of Stay, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Stress, Physiological
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