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Association of Elevated Pre-operative Hemoglobin A1c and Post-operative Complications in Non-diabetic Patients: A Systematic Review

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Abstract

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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Acknowledgements

The first author is supported by a collaborative fund from MITACS and Medtronic, Canada, for duration of her Ph.D. training.

Author information

Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Negar Karimian, Petru Niculiseanu & Liane S. Feldman

  2. Division of Experimental Surgery, McGill University, Montreal, QC, Canada

    Negar Karimian & Liane S. Feldman

  3. McGill University Health Centre Libraries, Montreal, QC, Canada

    Alexandre Amar-Zifkin

  4. Department of Anesthesia, McGill University, Montreal, QC, Canada

    Francesco Carli

  5. Department of Surgery, McGill University, Montreal, QC, Canada

    Liane S. Feldman

  6. Montreal General Hospital, 1650 Cedar Ave, L9-404, Montreal, QC, H3G 1A4, Canada

    Liane S. Feldman

Authors
  1. Negar Karimian
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  2. Petru Niculiseanu
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  3. Alexandre Amar-Zifkin
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  4. Francesco Carli
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  5. Liane S. Feldman
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Corresponding author

Correspondence to Liane S. Feldman.

Appendix: Ovid Medline Search

Appendix: Ovid Medline Search

  1. 1.

    Hemoglobin A, Glycosylated/

  2. 2.

    Hemoglobins/

  3. 3.

    Limit 2 to year = ”1963–1975”

  4. 4.

    Hemoglobin A/

  5. 5.

    Limit 4 to year = ”1975–1983”

  6. 6.

    ((glycat* or glycosylat*) adj2 (hemoglobin* or haemoglobin* or hemo-globin* or haemoglobin*)).tw, kf.

  7. 7.

    (hba1c or “hb a1c” or hbaic or “hb aic”).tw, kf.

  8. 8.

    ((ic or 1c or aic or a1c) adj2 (hemoglobin* or haemoglobin* or hemo-globin* or haemoglobin* or hb or hba)).tw, kf.

  9. 9.

    (glycohemoglobin* or glyco-hemoglobin* or glycohaemoglobin* or glycohaemoglobin*).tw, kf.

  10. 10.

    1 or 3 or 5 or 6 or 7 or 8 or 9

  11. 11.

    exp preoperative care/

  12. 12.

    exp preoperative period/

  13. 13.

    (pre-op* or preop*).tw, kf.

  14. 14.

    (presurg* or pre-surg*).tw, kf.

  15. 15.

    ((before or prior or previous or undergoing) adj3 (surger* or surgic* or procedure*)).tw, kf.

  16. 16.

    11 or 12 or 13 or 14 or 15

  17. 17.

    exp perioperative care/

  18. 18.

    Perioperative period/

  19. 19.

    (perop* or per-op* or periop* or peri-op*).tw, kf.

  20. 20.

    Postoperative Period/

  21. 21.

    (postoperati* or (post adj2 operati*) or postsurg* or ((post or after or following) adj2 surg*) or posttransplant* or ((post or after or following) adj2 transplant*) or ((postdischarg* or post-discharg*) adj3 surg*)).tw, kf.

  22. 22.

    or/17–21

  23. 23.

    exp general surgery/

  24. 24.

    exp surgical procedures, operative/

  25. 25.

    (surger* or surgic*).tw, kf.

  26. 26.

    su.fs.

  27. 27.

    or/23–26

  28. 28.

    exp postoperative complications/

  29. 29.

    (Co or mo).fs.

  30. 30.

    (morbi* or mortalit* or adverse outcome* or complicat*).tw, kf.

  31. 31.

    28 or 29 or 30

  32. 32.

    10 and 16

  33. 33.

    10 and (22 or 27) and 31

  34. 34.

    32 or 33

  35. 35.

    “Predictive value of tests”/

  36. 36.

    Reference values/

  37. 37.

    Forecasting/

  38. 38.

    Prognosis/

  39. 39.

    exp risk/

  40. 40.

    (risk or risks or prognos* or predict*).tw, kf.

  41. 41.

    or/35–40

  42. 42.

    34 and 41

  43. 43.

    Animals/not (animals/and humans/)

  44. 44.

    42 not 43

  45. 45.

    (exp child/or exp infant/or adolescent/) not exp adult/

  46. 46.

    44 not 45

  47. 47.

    Remove duplicates from 46

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Karimian, N., Niculiseanu, P., Amar-Zifkin, A. et al. Association of Elevated Pre-operative Hemoglobin A1c and Post-operative Complications in Non-diabetic Patients: A Systematic Review. World J Surg 42, 61–72 (2018). https://doi.org/10.1007/s00268-017-4106-4

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