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Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes-the Sunderland (UK) Experience
Nehemiah Samuel1, Abdalla Mustafa2, Helen Hawkins1
1Department of Upper GI and Bariatric Surgery, Sunderland Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK.
Insights
Delaying bariatric surgery for poorly controlled diabetes is not justifiable. Patients with high HbA1c (≥8.5%) experience similar peri-operative complication rates and outcomes to those with well-controlled diabetes, indicating surgery can proceed without pre-operative optimization.
Area of Science:
- Metabolic and Bariatric Surgery
- Diabetology
- Surgical Outcomes Research
Background:
- UK guidelines suggest HbA1c < 8.5% before elective surgery.
- Optimizing pre-operative glycemic control in diabetics can be challenging.
- The study investigates the impact of pre-operative HbA1c on surgical outcomes.
Purpose of the Study:
- To correlate pre-operative HbA1c levels with peri-operative complication rates in bariatric surgery.
- To determine if elective bariatric surgery should be delayed in patients with poorly controlled diabetes (HbA1c ≥ 8.5%).
Main Methods:
- Retrospective analysis of consecutive patients undergoing laparoscopic bariatric surgery (2014-2018).
- Patients categorized into three groups: non-diabetics (HbA1c < 6.5%), well-controlled diabetics (6.5-8.4%), and poorly controlled diabetics (≥ 8.5%).
- Primary outcome assessed was peri-operative complication rates.
Main Results:
- Early complication rates were low and similar across all groups (1.0% vs 1.7% vs 1.1%, p=0.592).
- No significant differences in mean length of stay or 30-day re-admission rates were observed between groups.
- Sustained and equal reduction in HbA1c was noted at 6 months and 1 year post-surgery in all groups.
Conclusions:
- Metabolic surgery for poorly controlled diabetes yields non-inferior peri-operative outcomes.
- Delaying metabolic surgery to optimize glycemic control is not clinically justifiable based on these findings.
Purpose:
UK guidelines recommend an HbA1c < 8.5% prior to elective surgery. Optimisation of pre-operative glycaemic control can be often difficult. Aim to correlate the effect of pre-operative HbA1c on the peri-operative complication rates and whether elective bariatric surgery should be delayed in poorly controlled diabetics.
Material And Methods:
Retrospective data of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass, one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy during January 2014 and April 2018. Patients were categorised into group 1, non-diabetics with an HbA1c < 6.5%; group 2, well-controlled diabetics with HbA1c between 6.5 and 8.4%; and group 3, poorly controlled diabetics with HbA1c ≥ 8.5%. Primary outcome was peri-operative complication rates.
Results:
Group 1 (n = 978), 81.8% female, median (i.q.r.) age 44.0 (34-52) years, median (i.q.r.) BMI 42.0 (38.7-46.7); group 2 (n = 350), 66.3% female, age 51.0 (45-59) years, BMI 41.8 (37.5-46.5); and group 3 (n = 90), 60% female, age 52.0 (45-56) years and BMI 41.4(36.9-44.8). Early complication rates in each group were low, 1.0% vs 1.7% vs 1.1% (p = 0.592). Mean length of stay was 2 days across the groups (p > 0.05). There was no difference in 30-day re-admission rates between groups 2.8%, 2.9% and 3.3% (p = 0.983). At 6 months and 1 year, there was sustained and equal reduction in HbA1c in all groups (p < 0.05).
Conclusion:
Patients undergoing metabolic surgery for poorly controlled diabetes achieve non-inferior peri-operative outcomes. Hence, delaying metabolic surgery in an attempt to optimise diabetic control is not justifiable.
