scholarly journals Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

Diabetes Care ◽  
2020 ◽  
Vol 44 (1) ◽  
pp. 107-115
Author(s):  
Hsiu-Yin Chiang ◽  
Kuan-Ting Robin Lin ◽  
Ya-Luan Hsiao ◽  
Han-Chun Huang ◽  
Shih-Ni Chang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Parenteral Nutrition-Associated Hyperglycemia in Noncritically Ill Inpatients Is Associated with Higher Mortality

2010 ◽  
Vol 24 (7) ◽  
pp. 453-457 ◽  
Author(s):  
Sofia Sarkisian ◽  
Tanis R Fenton ◽  
Abdel Aziz Shaheen ◽  
Maitreyi Raman
Keyword(s):  
Renal Failure ◽  
Blood Glucose ◽  
Parenteral Nutrition ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Glucose Monitoring ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Coronary Events ◽  
Mean Blood Glucose

BACKGROUND: Hyperglycemia is a marker of poor clinical outcomes in studies evaluating hospitalized critically ill patients.OBJECTIVES: To identify whether glycemic control is associated with health outcomes including acute coronary events, renal failure, infection, hospital length of stay, intensive care unit (ICU) admission, sepsis and mortality in noncritically ill patients administered parenteral nutrition (PN), and to compare the current standard of care for glucose monitoring at the Foothills Medical Centre (Calgary, Alberta) with the 2009 American Society of Parenteral and Enteral Nutrition guidelines.METHODS: A retrospective chart review of 100 adult (18 years of age or older) non-ICU inpatients who received PN for seven days or longer at the Foothills Medical Centre was conducted.RESULTS: Seventeen patients (17%) had a mean blood glucose level of 10.0 mmol/L or greater. PN patients with a mean blood glucose level of 10 mmol/L or greater had a higher rate of mortality than patients with a mean blood glucose level of less than 10 mmol/L (OR 7.22; 95% CI 1.08 to 48.29; P=0.042). Hyperglycemia was independently and significantly associated with mortality when adjusted for age and sex. Acute coronary events, renal failure, infection, hospital length of stay, ventilator use and ICU admissions were not associated with hyperglycemia. Only one-half of those with hyperglycemia, and none of the patients in the euglycemic group, received adequate glucose monitoring during the first two days of PN.CONCLUSION: Hyperglycemia in noncritically ill inpatients receiving PN was found to be a risk factor for increased mortality.

scholarly journals Hyperglycemia: A Predictor of Death in Severe Head Injury Patients

2016 ◽  
Vol 9 ◽  
pp. CMED.S40330 ◽  
Author(s):  
Simin Babaie Kafaki ◽  
Kamaledin Alaedini ◽  
Ashkan Qorbani ◽  
Leila Asadian ◽  
Kaveh Haddadi
Keyword(s):  
Blood Glucose ◽  
Head Injury ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Blood Glucose Level ◽  
Prospective Study ◽  
Glucose Level ◽  
Severe Head Injury ◽  
Hospital Length Of Stay ◽  
Comprehensive Treatment

Objectives Management of hyperglycemia during an acute sickness in adults is accompanied by improved outcomes. We have designed a prospective study with meticulous attention to exclude all diabetes patients by checking hemoglobin A1c (HbA1c or glycated hemoglobin) to avoid the ill-effects of hyperglycemia in patients with traumatic head injury admitted to the intensive care unit (ICU). Methods This prospective study included adults with traumatic primary brain injury with a Glasgow coma score of ≥8 necessitating mechanical ventilation treated in the period 2012–2015. After screening 311 patients, 220 were included in the study. Both blood glucose and HbA1c levels of all the patients at admission, as well as blood glucose level after 72 hours, were obtained from the records. The patients were later grouped based on their admission blood glucose levels (<200 mg/dL or ≤200 mg/dL). Injury severity score (ISS) was documented for every patient. As a final point, the outcomes were determined based on the hospital length of stay (HLS) and ICU length of stay (ILS), plusmortality rates. Results About 39% ( n = 85) of patients were admitted with hyperglycemia during the study period. The mortality rate in patients with glucose ≤200 mg/dL was 65.8% ( N = 56), against 23.7% ( N = 32) in the group with glucose <200 mg/dL, with mortality rising as the blood glucose level increased ( P = 0.014). Conclusions We conclude that admission hyperglycemia is related with increased mortality rate in head injury patients, and comprehensive treatment of hyperglycemia can improve the outcome of severe head injury patients.

scholarly journals Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Kuan-Ting Robin Lin ◽  
Hsiu-Yin Chiang ◽  
Ya-Luan Hsiao ◽  
Han-Chun Huang ◽  
Shih-Ni Chang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Missing Values ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Adjusted Relative Risk ◽  
Adjusted Risk ◽  
Laparoscopic Cholecystectomy Group

<b>OBJECTIVE</b><b> </b> <p>To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values.</p> <p><b>RESULTS</b></p> <p>We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL.</p> <p><b>CONCLUSIONS</b></p> <p>We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.</p>

scholarly journals Association Between Preoperative Blood Glucose Level and Hospital Length of Stay for Patients Undergoing Appendectomy or Laparoscopic Cholecystectomy

2020 ◽  
Author(s):  
Kuan-Ting Robin Lin ◽  
Hsiu-Yin Chiang ◽  
Ya-Luan Hsiao ◽  
Han-Chun Huang ◽  
Shih-Ni Chang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Missing Values ◽  
Medical Center ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Adjusted Relative Risk ◽  
Adjusted Risk ◽  
Laparoscopic Cholecystectomy Group

<b>OBJECTIVE</b><b> </b> <p>To evaluate the effect of preoperative blood glucose (POBG) level on hospital length of stay (LOS) in patients undergoing appendectomy or laparoscopic cholecystectomy. </p> <p><b>RESEARCH DESIGN AND METHODS</b></p> <p>We conducted a retrospective cohort study of patients aged ≥18 years who had undergone either appendectomy or laparoscopic cholecystectomy procedures between 2005 and 2016 at a tertiary medical center in Taiwan. The association between POBG level and LOS was evaluated using a multivariable quasi-Poisson regression with robust variance. Multiple imputations were performed to replace missing values.</p> <p><b>RESULTS</b></p> <p>We included a total of 8,291 patients; 4,025 patients underwent appendectomy (appendectomy group) and 4,266 underwent laparoscopic cholecystectomy (laparoscopic cholecystectomy group). In the appendectomy group, patients with POBG levels of ≥123 mg/dL (adjusted relative risk [aRR], 1.19; 95% CI, 1.06–1.33) had a 19% higher risk of having a LOS of >3 days than did those with POBG levels of <106 mg/dL. In the laparoscopic cholecystectomy group, patients with POBG levels of ≥128 mg/dL also had a significantly higher risk of having a LOS of >3 days (aRR, 1.17; 95% CI, 1.07–1.29) than did those with POBG levels of <102 mg/dL. A positive dose–response curve between POBG and an adjusted risk of a LOS of >3 days was observed, despite the curve starts to flatten at a POBG level of approximately 130 mg/dL.</p> <p><b>CONCLUSIONS</b></p> <p>We demonstrated that a higher POBG level was significantly associated with a prolonged LOS for patients undergoing appendectomy and laparoscopic cholecystectomy. The optimal POBG level may be lower than that commonly perceived.</p>

scholarly journals Hubungan Kadar Glukosa Darah Saat Masuk Rumah Sakit Dengan Lama Hari Rawat Pasien Sindrom Koroner Akut (SKA) Di RSUP Dr. M. Djamil Padang

2013 ◽  
Vol 2 (2) ◽  
pp. 94
Author(s):  
Rosi Oktarina ◽  
Yertizal Karani ◽  
Zulkarnain Edward
Keyword(s):  
Acute Coronary Syndrome ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Stroke Volume ◽  
Hospital Admission ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Cross Sectional ◽  
Random Blood Glucose ◽  
Coronary Syndrome

AbstrakHiperglikemia masih menjadi topik penelitian yang sering dihubungkan dengan kejadian sindrom koroner akut (SKA) di dunia, terutama hiperglikemia saat masuk rumah sakit. Hal ini didasari oleh beberapa pengaruh kadar glukosa darah yang tinggi terhadap sistem kardiovaskuler seperti gangguan fungsi ventrikel kiri, stroke volume yang menurun, regurgitasi katup mitral berulang, gangguan pada waktu pengisian diastolik hingga risiko tinggi untuk arritmia, serta hubungannya dengan peningkatan risiko trombosis. Sehingga semakin memperjelas pengaruh hiperglikemia yang tidak hanya dapat meningkatkan risiko terjadinya SKA, melainkan juga dapat memperburuk kondisi pasien SKA sendiri. Penelitian ini bertujuan mengidentifikasi hubungan kadar glukosa darah sewaktu dengan lama hari rawat pasien Sindrom Koroner Akut (SKA). Jenis penelitian yang digunakan adalah penelitian analitik dengan menggunakan desain penelitian Cross Sectional Study. Penelitian ini menggunakan data sekunder yang diambil di Instalasi Rekam Medik (Medical Record), yakni data rekam medik pasien yang didiagnosis sebagai Sindrom Koroner Akut (SKA) yang dirawat inap di Rumah Sakit Umum Pusat DR. M. Djamil Padang Periode Januari–Desember 2011. Ditemukan sebagian besar pasien SKA masuk rumah sakit dengan kadar Glukosa Darah Sewaktu (GDS) sebesar ≥ 200 mg/dl (40%) dan lama hari rawat sebesar ≥ 7 hari (52%). Dari hasil analisa bivariat dengan menggunakan uji korelasi Spearman ditemukan adanya hubungan searah antara kadar glukosa darah saat masuk rumah sakit dengan lama hari rawat pasien SKA dengan kekuatan hubungan yang sedang, r = +0,492, p = 0, 000 (p<0,05). Pemantauan terhadap kadar GDS yang diperiksa saat pasien masuk rumah sakit perlu dilakukan dan untuk penelitian yang akan datang diharapkan dapat diteliti lebih lanjut faktor-faktor lain yang mempengaruhi lama hari rawat pasien SKA.Kata kunci: Kadar glukosa darah saat masuk RS, lama hari rawatAbstractHyperglicemia is still become a research topic which is often associated with the incidence of Acute Coronary Syndrome (ACS) in the world, especially hyperglicemia on hospital admission. This is due to several effects of high random blood glucose to the cardiocasculer system for instance impaired left ventricular function, decreased stroke volume, reccurrent mitral valve regurgitation, impaired diastolic filling, high risk arrhytmias and its corelation with the increase thrombosis risk. This circumstance explains more about the effects of hyperglicemia that not only increase the risk of Acute Coronary Syndrome (ACS), but can also worsen the Acute Coronary Syndrome (ACS) patients condition through a various of mechanisms. This research is purposed to identify the relation between hospital admission blood glucose level with length of stay of Acute Coronary Syndrome (ACS). This research uses analytic research which is using cross sectional design. This research uses secondary data that is taken from the medical records of patients diagnosed as Acute Coronary Syndrome (ACS) admitted to RSUP DR. M. Djamil Padang from January until December 2011. Research found that the most of ACS patients admitted to the hospital with as random blood glucose of ≥200 mg/dl (40%) and length of stay for ≥7 days (52%). The results of bivariate analysis by using Spearman correlation test is obtained the correlation between hospital admission blood glucose level to length of stay ACS patients and the strength of correlation is moderate, r = +0,492 , p = 0, 000 (p<0,05). The monitoring of random glucose level of ACS patients upon hospitalization is necessary and for future studies the other factors that affect the length of stay of ACS patients should be considered.Keywords:Hospital admission blood glucose, length of stay

Patterns and Effects of Admission Hyperglycemia And Inflammatory Response in Trauma Patients: A Prospective Study

2020 ◽  
Author(s):  
Ayman El-Menyar ◽  
Mohammad Asim ◽  
Fayaz Mir ◽  
Suhail Hakim ◽  
Ahad Kanbar ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Length Of Stay ◽  
Inflammatory Response ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Severity Of Injury ◽  
Hs Crp ◽  
Initial Blood

Abstract Background: Hyperglycemia following trauma could be a response to stress. The constellation of the initial hyperglycemia, proinflammatory cytokines and severity of injury among trauma patients is understudied. We aimed to evaluate the patterns and effects of on-admission hyperglycemia and inflammatory response in a level 1 trauma center admissions. Methods: A prospective, observational study was conducted for adult trauma patients who were admitted and tested for on-admission blood glucose, hemoglobin A1c, interleukin (IL)-6 ,Il-18 and hs-CRP. Patients were categorized into 4 groups (non-diabetic normoglycemic, diabetic normoglycemic, diabetic hyperglycemic (DH) and stress-induced hyperglycemic (SIH)). The inflammatory markers were measured on 3 time points (admission, 24 h, and 48 h). Pearson’s correlation test and logistic regression analysis were performed. We hypothesized that higher initial readings of blood glucose and cytokines are associated with severe injuries and worse in-hospital outcomes in trauma patients.Results: During the study period, 250 adult trauma patients were enrolled. Almost 13% of patients presented with hyperglycemia (SIH&DH); of whom 50% had SIH. Compared to the other 3 groups; SIH patients were younger, had significantly higher ISS, higher IL-6 readings, prolonged hospital length of stay and higher mortality. The SIH group had lower Revised Trauma Score (p=0.005), lower Trauma Injury Severity Score (p=0.01) and lower GCS (p=0.001). IL-18 and hs-CRP were comparable among the study groups. Compared to the normoglycemia groups, patients with hyperglycemia had elevated high- sensitive troponin T (p=0.001) and required more blood transfusion (p=0.03). Patients with hyperglycemia had 3-times higher in-hospital mortality than the normoglycemia groups (p=0.02). A significant correlation was identified between initial blood glucose and serum lactate, IL-6, ISS and hospital length of stay. IL-6 correlated well with ISS (r=0.40, p=0.001). On- admission blood glucose had age-sex-GCS adjusted odd ratio 1.20(95% CI 1.06-1.33, p=0.003) for severe injury (ISS≥16).Conclusions: On-admission hyperglycemia is associated with a significant severer injury than normoglycemia patients. Initial blood glucose correlates with serum IL-6 which indicates a potential role of the systemic inflammatory response in the disease pathogenesis among the injured patients. On-admission glucose level could be a useful marker of injury severity, triage and risk assessment in trauma patients.This study was registered at the ClinicalTrials.gov (Identifier: NCT02999386), retrospectively Registered on December 21, 2016 https://clinicaltrials.gov/ct2/show/NCT02999386.

scholarly journals Preoperative Dexamethasone Enhances Quality of Recovery after Laparoscopic Cholecystectomy

2011 ◽  
Vol 114 (4) ◽  
pp. 882-890 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Steven B. Greenberg ◽  
Michael J. Avram ◽  
Jeffery S. Vender ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Postanesthesia Care Unit ◽  
Control Group ◽  
Quality Of Recovery ◽  
Pain Scores ◽  
Dexamethasone Group

Background The effect of dexamethasone on quality of recovery after discharge from the hospital after laparoscopic surgery has not been examined rigorously in previous investigations. We hypothesized that preoperative dexamethasone would enhance patient-perceived quality of recovery on postoperative day 1 in subjects undergoing laparoscopic cholecystectomy. Methods One hundred twenty patients undergoing outpatient laparoscopic cholecystectomy were randomized to receive either dexamethasone (8 mg) or placebo-saline. A 40-item quality-of-recovery scoring system (QoR-40) was administered preoperatively and on postoperative day 1 to all subjects. Nausea, vomiting, fatigue, and pain scores were recorded at the time of discharge from the postanesthesia care unit and ambulatory surgical unit. Hospital length of stay was also assessed. Results Global QoR-40 scores on postoperative day 1 were higher in the dexamethasone group (median [range], 178 [130-195]) compared with the control group (161 [113-194]) (median difference [99% CI], -18 [-26 to -8]; P &lt; 0.0001). Postoperative QoR-40 scores in the dimensions of emotional state, physical comfort, and pain were all improved in the dexamethasone group compared with the control group (P &lt; 0.001). Nausea, fatigue, and pain scores were all reduced in the dexamethasone group during the hospitalization, as were postoperative analgesic requirements (P &lt; 0.05). Total hospital length of stay was also reduced in subjects administered steroids (P = 0.003). Conclusions Among patients undergoing outpatient laparoscopic cholecystectomy surgery, the use of preoperative dexamethasone enhanced postdischarge quality of recovery and reduced nausea, pain, and fatigue in the early postoperative period.

scholarly journals A predictive grading scale for acute cholecystitis

2019 ◽  
Vol 4 (1) ◽  
pp. e000324
Author(s):  
Sammy Siada ◽  
David Jeffcoach ◽  
Rachel C Dirks ◽  
Mary M Wolfe ◽  
Amy M Kwok ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Acute Cholecystitis ◽  
Hospital Length ◽  
Systemic Inflammatory Response ◽  
Hospital Length Of Stay ◽  
Gallstone Pancreatitis ◽  
Grading Scale

BackgroundAcute cholecystitis presents in a spectrum of severity, where acute disease may be complicated by severe inflammation, gangrene, and perforation. The goal of this study is to outline an evidence-based grading scale that predicts patient outcomes after laparoscopic cholecystectomy (LC).MethodsA retrospective review of all patients with a preoperative diagnosis of acute cholecystitis who underwent LC from August 2011 until June 2015 at a tertiary-level hospital was performed. Patients who underwent elective cholecystectomy, incidental cholecystectomy, a planned open cholecystectomy, had gallstone pancreatitis or choledocholithiasis, and those admitted to a non-surgical service were excluded. Severity of disease was obtained from operative and pathology reports, and patients were classified according to the following grading scale:Grade I: symptomatic cholelithiasis.Grade II: acute/chronic cholecystitis.Grade III: gangrenous/necrotizing cholecystitis.Grade IV: gallbladder perforation or abscess.The groups were compared on age, gender, body mass index, severity of gallbladder disease, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, length of operation, complications within 30 days, conversion to open rate, and cost of hospitalization.ResultsDuring the study period, 1252 patients who underwent laparoscopic cholecystectomy were analyzed; 677 met inclusion criteria. The most common grade was grade 2, which was present in 80% of patients, followed by grade 3, which was found in 16% of patients. Grade 4 cholecystitis occurred in 1.2% of patients and grade 1 occurred in 3.2% of patients. There were statistically significant increases in age, presence of preoperative systemic inflammatory response syndrome, hospital length of stay, conversion to open rate, cost of hospitalization, and length of operation with increased cholecystitis grade.ConclusionsThe proposed grading scale is an accurate predictor of duration of operation, conversion to open rate, hospital length of stay, and cost of hospitalization.Level of evidenceIIIStudy typePrognostic

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