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High preoperative HbA1c does not affect early or late complication rates after bariatric surgery

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Abstract

Background

Preoperative HbA1c has been associated with an increased incidence of postoperative morbidity and mortality after abdominal and cardiovascular surgery. The literature on bariatric surgery is inconclusive and guidelines recommend postponement of surgery when HbA1c is above an arbitrary threshold (≥ 8.5%). In this study, we sought to understand the impact of preoperative HbA1c on early and late postoperative complications.

Methods

We performed a retrospective analysis of prospectively collected data on obese patients with diabetes who underwent laparoscopic bariatric surgery. Patients were categorized into three groups according to their preoperative HbA1c level: < 6.5% (group 1), 6.5–8.4% (group 2) and ≥ 8.5% (group 3). Primary outcomes were early and late postoperative complications (< and > 30 days, respectively) that were differentiated based on severity (major/minor). Secondary outcomes were length of stay (LOS), duration of surgery, and rate of readmission.

Results

In total, 6798 patients underwent laparoscopic bariatric surgery from 2006 to 2016, of which 1021 (15%) patients had Type 2 Diabetes (T2D). Complete data with a median follow-up of 45 months (3–120) were available for 914 patients with HbA1c < 6.5% (n = 227, 24.9%), 6.5–8.4% (n = 532, 58.5%) and ≥ 8.5% (n = 152, 16.6%). Early major surgical complication rate was similar across the groups ranging from 2.6 to 3.3%. No associations between high preoperative HbA1c and late complications—medical as well as surgical—was observed. Groups 2 and 3 had statistically significant more pronounced inflammatory status. LOS (1.8–1.9 days), readmission rates (1.7–2.0%) and surgical time was similar across the three groups.

Conclusion

Elevated HbA1c is not associated with more early or late postoperative complications, longer LOS, longer surgical time or higher rates of readmission.

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Data availability

All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Aleris Obesity Clinic and Department of Surgery, Aleris Hospital, Oslo, Norway

    Kamran Shah & Hjörtur Gislason

  2. GB Obesitas, Metabolic and Bariatric Unit, Skeppsbron 11, 211 205, Malmö, Sweden

    Kamran Shah & Hjörtur Gislason

  3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Ismail Gögenur

  4. Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark

    Ismail Gögenur

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  1. Kamran Shah
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Correspondence to Kamran Shah.

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Shah, K., Gögenur, I. & Gislason, H. High preoperative HbA1c does not affect early or late complication rates after bariatric surgery. Surg Endosc 37, 5313–5319 (2023). https://doi.org/10.1007/s00464-023-10009-w

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  • DOI: https://doi.org/10.1007/s00464-023-10009-w

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