Elevated hemoglobin A1c level and bariatric surgery complications

Area of Science:

• Metabolic Surgery
• Surgical Outcomes Research
• Diabetes Management

Background:

• Elevated glycosylated hemoglobin (HbA1c) is a known risk factor for complications in cardiac and orthopedic surgery.
• Limited evidence exists regarding the impact of preoperative HbA1c on postoperative outcomes in bariatric surgery.

Purpose of the Study:

• To evaluate the association between preoperative HbA1c levels and early postoperative complications in patients undergoing bariatric surgery.
• To determine if elevated HbA1c is a significant predictor of adverse outcomes post-bariatric procedures.

Main Methods:

• Retrospective analysis of 118,742 patients undergoing laparoscopic sleeve gastrectomy or Roux-En-Y Gastric Bypass (2017-2018) from the MBSAQIP database.
• Patients were grouped by HbA1c cutoffs (≤8% vs >8% and ≤10% vs >10%).
• Propensity score matching (PSM) was utilized to balance covariates, followed by statistical analysis of complication rates.

Main Results:

• After PSM, elevated HbA1c (>8%) was not significantly associated with increased composite postoperative complications (p=0.22).
• Patients with HbA1c ≤10% showed more composite complications compared to those with HbA1c >10% (p<0.001).
• Subgroup analysis for sleeve gastrectomy and gastric bypass did not reveal worsened outcomes for HbA1c >8%, but HbA1c ≤10% was linked to more complications.

Conclusions:

• Preoperative HbA1c levels >8% or >10% were not associated with increased postoperative complications in this bariatric surgery cohort.
• HbA1c levels below 10% were associated with certain adverse outcomes, suggesting a complex relationship.
• Elevated HbA1c alone may not be a contraindication for bariatric surgery, but further research is needed.