Postoperative Length of Stay in Patients With Stress Hyperglycemia Compared to Patients With Diabetic Hyperglycemia: A Retrospective Cohort Study
Open accessAbstract
Background: 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. Methods: 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. Results: 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; P = .03). Within the SH group, we found no association between LOS and prompt treatment of hyperglycemia within 12 hours ( P = .43), insulin dose per day ( P = .89), or overall mean glucose ( P = .13). Conclusions: 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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
People who develop stress hyperglycaemia have more adverse peri-operative outcomes than those with diabetes mellitus.
“People who develop stress hyperglycaemia have more adverse peri‐operative outcomes than those with diabetes mellitus [78, 79, 80].”
Cites
2. Classification and Diagnosis of Diabetes: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s002 · Cited by 4,792 · see citing works
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes
Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.3.8341 · Cited by 2,195 · see citing works
Prevalence and clinical outcome of hyperglycemia in the perioperative period in noncardiac surgery
Frisch, A., Chandra, P., Smiley, D., Peng, L., Rizzo, M., Gatcliffe, C., Hudson, M., Mendoza, J., Johnson, R., Lin, E., et al. (2010) · Diabetes Care · doi:10.2337/dc10-0304 · Cited by 739 · see citing works
Lazar, H. L., Chipkin, S. R., Fitzgerald, C. A., Bao, Y., Cabral, H., & Apstein, C. S. (2004) · Circulation · doi:10.1161/01.cir.0000121747.71054.79 · Cited by 715 · see citing works
Kwon, S., Thompson, R., Dellinger, P., Yanez, D., Farrohki, E., & Flum, D. (2013) · Annals of Surgery · doi:10.1097/sla.0b013e31827b6bbc · Cited by 598 · see citing works
Self-citationPerioperative Hyperglycemia and Risk of Adverse Events Among Patients With and Without Diabetes
Kotagal, M., Symons, R. G., Hirsch, I. B., Umpierrez, G. E., Dellinger, E. P., Farrokhi, E. T., & Flum, D. R. (2015) · Annals of Surgery · doi:10.1097/sla.0000000000000688 · Cited by 441 · see citing works
Ramos, M., Khalpey, Z., Lipsitz, S., Steinberg, J., Panizales, M. T., Zinner, M., & Rogers, S. O. (2008) · Annals of Surgery · doi:10.1097/sla.0b013e31818990d1 · Cited by 380 · see citing works
16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D. M., Johnson, E. L., et al. (2022) · Diabetes Care · doi:10.2337/dc23-s016 · Cited by 226 · see citing works
Stress-Induced Hyperglycemia: Consequences and Management
Vedantam, D., Poman, D. S., Motwani, L., Asif, N., Patel, A., & Anne, K. K. (2022) · Cureus · doi:10.7759/cureus.26714 · Cited by 167 · see citing works
Guzman, J. Z., Iatridis, J. C., Skovrlj, B., Cutler, H. S., Hecht, A. C., Qureshi, S. A., & Cho, S. K.-W. (2014) · Spine · doi:10.1097/brs.0000000000000482 · Cited by 154 · see citing works
Comino, E. J., Harris, M., Islam, M. D. F., Tran, D. T., Jalaludin, B. B., Jorm, L. R., Flack, J. R., & Haas, M. R. (2015) · BMC Health Services Research · doi:10.1186/s12913-014-0666-2 · Cited by 124 · see citing works
Eliminating the Diabetic Disadvantage: The Portland Diabetic Project
Furnary, A. P., & Wu, Y. (2006) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.1053/j.semtcvs.2006.04.005 · Cited by 114 · see citing works
Yong, P. H., Weinberg, L., Torkamani, N., Churilov, L. P., Robbins, R., Ma, R., Bellomo, R., Lam, Q. T., Burns, J. D., Hart, G. K., et al. (2018) · Diabetes Care · doi:10.2337/dc17-2304 · Cited by 103 · see citing works
The Impact of Diabetes Mellitus on Patients Undergoing Degenerative Cervical Spine Surgery
Guzman, J. Z., Skovrlj, B., Shin, J. I., Hecht, A. C., Qureshi, S. A., Iatridis, J. C., & Cho, S. K.-W. (2014) · Spine · doi:10.1097/brs.0000000000000498 · Cited by 92 · see citing works
Stress hyperglycemia in general surgery: Why should we care?
Davis, G., Fayfman, M., Reyes-Umpierrez, D., Hafeez, S., Pasquel, F. J., Vellanki, P., Haw, J. S., Peng, L., Jacobs, S., & Umpierrez, G. E. (2018) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.11.010 · Cited by 80 · see citing works
Chen, J. Y., Nassereldine, H., Cook, S. B., Thornblade, L. W., Dellinger, E. P., & Flum, D. R. (2022) · JAMA Surgery · doi:10.1001/jamasurg.2021.5561 · Cited by 56 · see citing works
Impact of Diabetes Mellitus on Head and Neck Cancer Patients Undergoing Surgery
Raikundalia, M. D., Fang, C. H., Spinazzi, E. F., Vázquez, A. L., Park, R. C., Baredes, S., & Eloy, J. A. (2015) · Otolaryngology · doi:10.1177/0194599815607852 · Cited by 51 · see citing works
Interventions To Decrease Hospital Length of Stay
Tipton, K. N., Leas, B. F., Mull, N. K., Siddique, S. M., Greysen, S. R., Lane-Fall, M. B., & Tsou, A. Y. (2021) · doi:10.23970/ahrqepctb40 · Cited by 48 · see citing works
Nair, B. G., Neradilek, M. B., Newman, S.-F., & Horibe, M. (2018) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2018.10.024 · Cited by 34 · see citing works
WORLEY, N. J., Buza, J. A., Jalai, C. M., POORMAN, G. W., Day, L. M., Vira, S. N., McClelland, S., Lafage, V., & Passias, P. G. (2017) · The International Journal of Spine Surgery · doi:10.14444/4010 · Cited by 33 · see citing works
Mamtani, M., Kulkarni, H. R., Bihari, S., Prakash, S., Chavan, S., Huckson, S., & Pilcher, D. V. (2019) · Journal of Critical Care · doi:10.1016/j.jcrc.2019.11.003 · Cited by 29 · see citing works
The Glycemic Ratio Is Strongly and Independently Associated With Mortality in the Critically Ill
Roberts, G., Krinsley, J. S., Preiser, J., Quinn, S. J., Rule, P. R., Brownlee, M., Schwartz, M. W., Umpierrez, G. E., & Hirsch, I. B. (2022) · Journal of Diabetes Science and Technology · doi:10.1177/19322968221124114 · Cited by 22 · see citing works
Outcomes associated with hyperglycemia after abdominal aortic aneurysm repair
Tarbunou, Y. A., Smith, J. B., Kruse, R. L., & Vogel, T. R. (2018) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2018.05.240 · Cited by 15 · see citing works
Validation of Diagnostic Coding for Diabetes Mellitus in Hospitalized Patients
Ren, C. C., Abusamaan, M. S., & Mathioudakis, N. N. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.01.014 · Cited by 10 · see citing works
Postoperative Hyperglycemia in Patients with and without Diabetes After Major Joint Replacement
Mannion, J. D., Rather, A., Manifold, S., Gardner, K., McEvilly, M., Yaeger, J., & Siegelman, G. (2021) · JBJS Open Access · doi:10.2106/jbjs.oa.20.00172 · Cited by 10 · see citing works
Case-control Investigation of Previously Undiagnosed Diabetes in the Critically Ill
Krinsley, J. S., Roberts, G., Brownlee, M., Schwartz, M. W., Preiser, J., Rule, P., Wang, Y., Bahgat, J., Umpierrez, G. E., & Hirsch, I. B. (2022) · Journal of the Endocrine Society · doi:10.1210/jendso/bvac180 · Cited by 6 · see citing works
The Paradox of Hyperglycemia and Surgical Outcomes in Patients with and without Diabetes
Thompson, R. E., Khor, S., Thornblade, L. W., Flum, D. R., & Sobel, M. (2019) · Surgical Infections · doi:10.1089/sur.2018.270 · Cited by 4 · see citing works
Self-citationDiabetes-Related Inpatient Stays, 2018
Fingar, K. R., & Reid, L. D. (2021) · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
El‐Boghdadly, K., Dhesi, J., Fabb, P., Levy, N., Lobo, D. N., McKechnie, A., Mustafa, O., Newland‐Jones, P., Patel, A., Pournaras, D. J., et al. (2025) · Anaesthesia · doi:10.1111/anae.16541 · Cited by 147 · see citing works
Advances in the management of hyperglycaemia and diabetes mellitus during hospitalization
Idrees, T., Castro-Revoredo, I., Dhatariya, K., Hernandez, L., & Umpierrez, G. E. (2025) · Nature Reviews Endocrinology · doi:10.1038/s41574-025-01157-1 · Cited by 18 · see citing works
Panayi, A. C., Knoedler, S. A., Alfertshofer, M. G., Matar, D. Y., Friedrich, S., Rühl, J., Haug, V., Gazyakan, E., Bigdeli, A. K., Kneser, U., et al. (2025) · Annals of Surgery · doi:10.1097/sla.0000000000006664 · Cited by 12 · see citing works
Practical application of semaglutide: From evidence-based research to expert decisions
Салухов, В. В., Galstyan, G. R., Khalimov, Y. S., Бакулин, И. Г., Cherkashin, D. V., Shadrichev, F. E., & Sukhotskaia, N. A. (2025) · Meditsinskiy sovet = Medical Council · doi:10.21518/ms2025-185 · Cited by 8 · see citing works
Mahmoudi, P. S., Sadeghi, F., Saberian, M., Khalili, H., & Shafaati, M. (2026) · Journal of Anesthesia Analgesia and Critical Care · doi:10.1186/s44158-025-00335-x · Cited by 3 · see citing works
Lan, N., Lai, M., Gao, Y., Wang, X., Chen, M., Bai, S., Wang, J., Yuan, W., & Ren, J. (2025) · BMC Cancer · doi:10.1186/s12885-025-14401-8 · Cited by 2 · see citing works
Mannion, J. D., Rather, A., Fisher, A., McEvilly, M., Gardner, K., & Siegelman, G. (2025) · BMC Surgery · doi:10.1186/s12893-025-03040-2
Wang, N., Zhang, J., Fei, C., Sun, Z., Duan, P., & Yang, L. (2026) · BMC Nursing · doi:10.1186/s12912-026-04400-w
- Authors
- Shiffermiller, J., Anderson, M., & Thompson, R.
- Affiliations
- University of Nebraska Medical Center (US)
- Snoqualmie Valley Hospital and Health District, Snoqualmie, WA, USA
- Corresponding author
- Shiffermiller, Jason
- Venue
- Journal of Diabetes Science and Technology
- Publisher
- SAGE Publications
- Published
- 2024-02-26
- Volume
- 18
- Issue
- 3
- Pages
- 556-561
- ISSN
- 1932-2968 (ISSN-L)
- PMC
- PMC11089853
- OpenAlex
- W4392168457
- Cited by
- 8
- References
- 28
- Citations by year
- 2026: 2 · 2025: 6
- Type
- conference abstract
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Diabetes Science and Technology (publishedVersion, other-oa)
- PubMed Central (publishedVersion, other-oa)
- PubMed (publishedVersion)
- 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 › Surgery › Enhanced Recovery After Surgery
- Keywords
- stress hyperglycemia, diabetic hyperglycemia, postoperative hospital stay, non-cardiac surgery, hyperglycemia treatment, insulin dose, HbA1c, diabetes mellitus, length of hospital stay
- MeSH terms
- Aged, Blood Glucose, Diabetes Mellitus, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Length of Stay, Male, Middle Aged, Postoperative Complications, Postoperative Period, Retrospective Studies, Cohort Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
