High Blood Sugar Before Surgery May Extend Hospital Stay

Diabetes patients with high blood sugar levels faced longer hospital stays after surgery

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) After surgery, patients often want to get out of the hospital as soon as possible. Diabetes, however, can lead to complications, and high blood sugar before surgery may lead to longer stays.

Diabetes is a known risk factor for those who are having surgery. It can raise the risk for infection and other complications, especially for those who have high blood sugar at the time of surgery.

A new study has found that those who had chronic high blood sugar (hyperglycemia) for several months leading up to surgery experienced longer than normal hospital stays.

"Get your blood sugar under control before surgery."

Rajesh Garg, MD, assistant professor of medicine in the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women's Hospital, an affiliate of Harvard Medical School, and his colleagues analyzed outcomes of 449 diabetes patients who had a A1c blood sugar reading within three months prior to surgery. Heart operations and same day surgeries were excluded. 

The A1C test (sometimes called the hemoglobin A1c or HbA1c test) is a measure of a person's average blood sugar levels over the past three months. The A1C test is the main test used for diabetes management and diabetes research. A normal A1C level is below 5.7 percent.

Patients were divided into four groups according to their A1c levels: those at or under 6.5 percent (109 patients), those greater than 6.5 and up to 8 percent (202 patients), those greater than 8 and up to 10 percent (91 patients) and those greater than 10 percent (47 patients).

The researchers compared results from these four groups with outcomes from 888 individuals without diabetes.

Dr. Garg and his team discovered that diabetes patients with an A1c greater than 8 percent had an increased length of stay in the hospital after surgery compared to those without diabetes.

The non-diabetes group averaged about five days in the hospital while the greater than 8 percent group averaged about eight days. Those above 10 percent A1c spent an average of 6.8 days in the hospital.

Those in the 6.5 to 8 percent A1c group had similar lengths of stay as those without diabetes.

Contrary to what might be expected, results also showed that diabetes patients with A1c readings that were less than 6.5 percent also had long hospital stays of about eight days. While an A1c level below 6.5 percent can be in the normal range, the authors wrote that these patients may have had a greater severity of underlying illness or they may have had dangerously low blood sugar levels (hypoglycemia), but that data was unavailable.

The authors wrote that hyperglycemia is associated with increased inflammation and oxidative stress, and poor endothelial function (related to the lining of blood vessels) and these factors “...can potentially affect the healing process after surgical procedures.”

Dr. Garg told dailyRx News, “[For those with a high A1C levels] I think there are multiple factors including increased risk of infections and poor healing that contribute to longer hospital stays. If a diabetic patient needs to undergo an elective surgery that can wait without causing any harm, try to control A1c below eight percent before surgery.”

This study was published online October 29 in Diabetes Care. Funding was provided by a Health Resources and Services Award (HRSA) and the US Department of Health and Human Services.

Review Date: 
October 31, 2013
Last Updated:
November 1, 2013