N. Sridhar1, E. Hetzel1, T. L. Kindel1, J. Gould1, R. Higgins1 1Medical College Of Wisconsin,Surgery,Milwaukee, WISCONSIN, USA
Introduction:
Pre-operative hemoglobin (Hb) A1c levels ≥ 8% have been associated with increased post-operative complications in surgical patients. Given the prevalence and physiology of diabetes among bariatric surgery patients, attaining a pre-operative HbA1c < 8% can be a challenge. The purpose of this study was to identify the impact of pre-operative HbA1c on post-operative outcomes in bariatric surgery patients.
Methods:
A retrospective chart review was conducted on diabetic patients who underwent primary bariatric surgery, including laparoscopic sleeve gastrectomy, gastric bypass or gastric banding, at a single institution between the years 2013 and 2019. Diabetic patients were defined as those with a HbA1c ≥ 6.5%. Patients were divided into two groups based on their pre-operative HbA1c levels of < 8% and ≥ 8%. Univariate analyses were performed to determine an association between pre-operative HbA1c levels and post-operative outcomes.
Results:
There were 351 primary bariatric surgery patients in the study period, 270 with HbA1c <8%, and 81 with HbA1c ≥ 8%. The HbA1c < 8% group had an average pre-operative HbA1c of 6.5% ± 0.9 compared to 9.0% ± 1.0 in the HbA1c ≥ 8% group (p<0.001). Laparoscopic sleeve gastrectomy was more frequently performed in the HbA1c < 8% group compared to HbA1c ≥ 8% group (49.3% vs 43.2%), versus the gastric bypass (50.4% vs 53.1%) and gastric banding (0.4% vs 3.7%) (p < 0.04). There was no statistically significant difference in any 30-day post-operative outcome between the two groups, including length of stay, overall complications, intensive care unit admission, hospital readmission, intraoperative complication, reoperation, return to the Emergency Department and mortality (Table 1). There was also no statistically significant difference in 2 week change in body mass index (4.7 kg/m2 ± 7.3 vs 5.3 kg/m2 ± 9.7, p=0.20) or 3 month change (8.3 kg/m2 ± 3.6 vs 7.4 kg/m2 ± 2.2, p=0.07) between the two groups. Post-operative HbA1c was significantly less in the HbA1c < 8% group both at the 3-6 month (6.0% ± 0.9 vs 7.4% ± 1.4, p<0.001) and 6-12 month (6.0% ± 1.1 vs 7.2% ± 1.4, p<0.001) post-operative follow-up.
Conclusion:
This study demonstrated no difference in post-operative outcomes of primary bariatric surgery patients based on a HbA1c cut-off of 8%. This highlights that given the prevalence and physiology of diabetes in bariatric surgery patients, surgery can be considered and safely performed in patients with a pre-operative HbA1c ≥ 8%. Attaining a HbA1c < 8% may not be feasible for some diabetic patients without bariatric surgery.
