Negar Karimian, MD1, Pepa Kaneva, PhD1, Nicolo Pecorelli, MD1, Carl W Ulysse, MD2, Stephan Robitaille, MD2, Julio F Fiore JR, PhD1, Francesco Carli, MD3, Liane S Feldman, MD1. 1Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, Qc, 2School of Medicine, McGill University, Montreal, Qc, 3Department of Anesthesiology,McGill University Health Centre, Montreal, Qc
Introduction- Hyperglycemia is associated with increased post-operative infections. HbA1c is a marker of long-term glucose control and in diabetics is an established indicator of poorer outcomes. However, whether sub-optimal HbA1c levels are associated with post-operative complications in non-diabetic patients is unclear. The purpose of the study was to estimate the extent to which elevated preoperative HbA1c is associated with post-operative infectious complications in non-diabetic patients undergoing colorectal surgery.
Methods- Patients with documented pre-operative HbA1c levels as the result of participation in 3 previous studies between 2012 and 2016 were reviewed. Patients without a previous diagnosis of diabetes undergoing elective open or laparoscopic colorectal surgery for benign and malignant conditions were included. Elevated HbA1c was defined as HbA1c≥5.7%. The primary outcome was overall infectious complications occurring within 30 days of surgery, defined as patients having at least one of the following: incisional surgical site infections (SSI) (superficial and deep), organ space SSI, urinary tract infection (UTI) and/or pneumonia. Complications were defined as per NSQIP. Secondary outcomes were overall complications, 30-day readmissions rate and hospital length of stay.
Results- A total of 266 patients with preoperative HbA1c were identified; 52(20%) were known diabetics and were excluded, and 213 patients were included (mean (SD) age 66.4(12.5) years, BMI 26.5(4.8) mg/kg2, 43% female, 77% laparoscopic). When grouped according to pre-operative HbA1c levels, 92 patients (43%) had HbA1c < 5.7% while 121 patients (57%) had HbA1c≥ 5.7 (pre-diabetes/provisional diabetes). There were no differences between the normal and elevated HbA1c groups for 30-day overall infections (13 (14%) vs 10(8%), p=0.2), incisional SSI (5(5%) vs 7(6%), p=0.9), organ space SSI (8(9%vs 7(6%), p=0.4), UTI (1(1%) vs 2(2%), p=1) or pneumonia (1(1%) vs 1(1%), p=1). There were also no differences in median (IQR) hospital stay (3(3-7) vs 4(3-6) days, p=0.9), overall complications (45(49%) vs 63 (52%), p= 0.6) or 30-day readmissions (11(12%) Vs 14(11%), p= 0.9).
Conclusions– In patients without known diabetes, elevated preoperative HbA1c was not associated with higher infectious complications after colorectal surgery. However, given the high percentage of pre-diabetes in this colorectal surgery population, more attention should be directed toward characterising this population and their post-operative outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80301
Program Number: P249
Presentation Session: Poster (Non CME)
Presentation Type: Poster