Michal Wysocki, MD1, Piotr Major, MD, PhD1, Tomasz Stefura1, Jakub Dros1, Artur Kacprzyk1, Katarzyna Chlopas1, Katarzyna Major2, Piotr Malczak1, Magdalena Pisarska1, Michal Pedziwiatr1, Andrzej Budzynski1. 12nd Department of General Surgery, Jagiellonian University Medical College, 2Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
Introduction: The aim of this study was to investigate the influence of baseline glycated hemoglobin level (HbA1c) level in bariatric patients on postoperative outcomes. Studies investigating the association of HbA1c with surgical outcomes have shown conflicting results. We found scarce of clinical data regarding influence of baseline HbA1c on bariatric surgeries postoperative morbidity and readmission what was inspiration to conduct this multicenter retrospective study.
Methods and Procedures: Retrospective cohort study analyzed patients who underwent laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) or mini-gastric bypass (MGB) for morbid obesity in seven referral bariatric centers. Patients were divided into groups depending on preoperative HbA1c: HbA1c <5.7%; 5.7-6.4% and ≥6.5%. Primary endpoints: influence of HbA1c level on perioperative (30-days) and postoperative (12-months) morbidity rates, operation time, length of hospital stay (LOS) and readmission rate.
Results: (32%). Median age was 43 (35-52) years. Median HbA1c was 5.7 (5.3-6.1). HbA1c<5.7% was present in 1044 patients (49%), HbA1c5.7-6.4% in 734 (35%), and HbA1c≥6.5% in 347 (16%). Percentage of male patients increased in groups from 26% in HbA1C<5.7% to 47% in HbA1C≥6.5% significantly. Same tendency through groups we observed in case of BMI and age. Uncontrolled diabetes (HbA1C ≥6.5%) was present in 185 (8.7%) patients, while 162 (7.62%) patients were not on antidiabetic medications despite having HbA1C ≥6.5%. Median operative time in patients with HbA1C≥6.5% was significantly longer than in HbA1C<5.7% and HbA1C 5.7-6.4%. 30-days morbidity rate was 5.27% (112 patients) and did not differ groups significantly, as 12-months morbidity rate (excl. 30-days) of 2.02% (43 patients). LOS did not differ groups significantly. 44 patients were readmitted in observation period (2.07%) in general. Patients having HbA1C in range of 5.7-6.4% and with HbA1C≥6.5% did not have significantly increased odds for perioperative morbidity, 12-months postoperative morbidity as compared with those with HbA1C<5.7%. Patients with HbA1c≥6.5% had increased OR for prolonged LOS as compared to those with HbA1C<5.7% (OR: 1.45; 95%CI: 1.07-1.97). HbA1c did not influence OR for readmissions. Patients with baseline HbA1c ≥8% had significantly increased chances for hospital readmission (OR 3.53, 95%CI: 1.35-9.21).
Conclusion: Baseline level of glycated hemoglobin did not influence chance for perioperative morbidity, 12-months postoperative morbidity and prolonged LOS. Patients with HbA1c ≥8% have increased chance for hospital readmissions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94546
Program Number: P168
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster