HbA1c and prolonged hospital stay
There are differences between studies in their definition of a prolonged
hospital stay (from ≥3 to 14 days) 51–53, which sheds
interesting light on the association between HbA1c and length of
hospital stay (LOS).
In a retrospective study (n=570), extended LOS was defined as
> 3 days12. They found that HbA1c was an
independent predictor of hospital stay regardless of blood sugar levels
(p = 0.001). Moreover, Medhi et al. found similar LOS results in
135 patients who underwent coronary artery bypass surgery; HbA1c ≥7%
was found to be strong predictor of LOS ≥ 6 days (p =
0.025)52. However, interestingly, when defining
prolonged LOS as ≥ 14 days, LOS was not affected by preoperative HbA1c
levels (with a cut-off of HbA1c = 7% for optimal and suboptimal levels;p = 0.367) 53.
It is noted that diabetic patient’s undergoing CABG, HbA1c levels
significantly correlated with postoperative length of stay (LOS).
Patients with suboptimal medium-term glycaemic control (HbA1c
> 7%, n=38) had longer LOS than patients with optimal
medium-term glycaemic control (HbA1c ≤ 7%, n=57) (mean postoperative
LOS 6 days vs. 7.5 days; postoperative LOS mean rank: 32 days vs 46
days; p = 0.008) 47.
The meta-analysis of five studies (n = 3,002) conducted by Wang et al.
reported a higher preoperative HbA1c level resulted in a 1.08-day mean
increase in hospital stay after cardiac surgery (WMD = 1.08, 95% CI
0.46-1.71) 48.
On the other hand, intensive care stay was not affected by the level of
HbA1c as several studies reported no significant difference in ICU days
between patients with lower preoperative HbA1c levels and those with
higher HbA1c levels after cardiac surgery 45,46,54,55.