Association of Elevated Pre-operative Hemoglobin A1c and Post-operative Complications in Non-diabetic Patients: A
Negar Karimian1,2, Petru Niculiseanu1, Alexandre Amar-Zifkin3
1Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
Insights
Pre-operative glycated hemoglobin (HbA1c) may predict surgical complications in non-diabetic patients. This finding suggests HbA1c is a valuable tool for assessing surgical risk in patients without a diabetes history.
Area of Science:
- Surgical outcomes research
- Endocrinology
- Clinical risk assessment
Background:
- Pre-operative hyperglycemia is linked to adverse surgical outcomes.
- Glycated hemoglobin (HbA1c) reflects long-term glycemic control, unlike random glucose.
- The role of pre-operative HbA1c in non-diabetic patients' surgical risk is unclear.
Purpose of the Study:
- To systematically review evidence on pre-operative HbA1c and post-operative outcomes.
- To assess if suboptimal HbA1c identifies non-diabetic patients at risk for complications.
Main Methods:
- Systematic review of observational studies.
- Comprehensive literature search across major databases.
- Inclusion of studies on adult surgical patients without prior diabetes diagnosis.
Main Results:
- Six studies were included; four found significant associations between HbA1c and complications.
- Post-operative infection rates varied; two studies showed increased rates, two found no difference.
- Length of stay and mortality showed mixed results, with one study noting higher mortality with suboptimal HbA1c.
Conclusions:
- Suboptimal pre-operative HbA1c may predict post-operative complications in non-diabetic patients.
- HbA1c represents a potentially modifiable risk factor for surgical outcomes.
- Further research is needed due to limited evidence.
Importance:
Pre-operative hyperglycemia is associated with post-operative adverse outcomes in diabetic and non-diabetic patients. Current pre-operative screening includes random plasma glucose, yet plasma glycated hemoglobin (HbA1c) is a better measure of long-term glycemic control. It is not clear whether pre-operative HbA1c can identify non-diabetic patients at risk of post-operative complications.
Objective:
The systematic review summarizes the evidence pertaining to the association of suboptimal pre-operative HbA1c on post-operative outcomes in adult surgical patients with no history of diabetes mellitus.
Evidence Review:
A detailed search strategy was developed by a librarian to identify all the relevant studies to date from the major online databases.
Findings:
Six observational studies met all the eligibility criteria and were included in the review. Four studies reported a significant association between pre-operative HbA1c levels and post-operative complications in non-diabetic patients. Two studies reported increased post-operative infection rates, and two reported no difference. Of four studies assessing the length of stay, three did not observe any association with HbA1c level and only one study observed a significant impact. Only one study found higher mortality rates in patients with suboptimal HbA1c.
Conclusions And Relevance:
Based on the limited available evidence, suboptimal pre-operative HbA1c levels in patients with no prior history of diabetes predict post-operative complications and represent a potentially modifiable risk factor.
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