Preoperative Glycosylated Haemoglobin (HbA1c) Does Impact on Postoperative Complications in Patients Undergoing Gastrointestinal and Hepatobiliary Surgery.

INTRODUCTION: The impact of preoperative glycated haemoglobin (HbA1c) in patients undergoing gastrointestinal and hepatobiliary surgery is unclear as data is limited.

METHODS: Patients undergoing gastrointestinal surgery attending pre-assessment screening (PAS) clinics from August to September 2016 at the Queen Elizabeth Hospital Birmingham (QEHB) were identifi ed. Outcome measure was postoperative complications as defi ned by the Clavien-Dindo classifi cation system.

RESULTS: In this study, 381 patients were included, of which 48% (181/381) had HbA1c measured. Of these, 27% (49/181) had a HbA1c ≥ 48 mmol/mol. Overall complications were 14% and major complication rates were 3% (11/381). In unadjusted models, patients with HbA1c ≥ 48 mmol/mol had signifi cantly higher rates of overall complications (odds ratio [OR] = 2.82, 95% confi dence interval [CI] = 1.22-6.49; p = 0.015). In adjusted models, only surgical grade was predictive of overall complications. In patients undergoing major surgery (n = 93), there were signifi cantly higher rates of overall complications in patients with HbA1c ≥ 48 mmol/mol as compared to those with HbA1c < 48 mmol/mol (63% vs. 46%, p = 0.043).

CONCLUSION: Utility of HbA1c to stratify patients undergoing gastrointestinal and hepatobiliary surgery into high-risk clinics is limited from this study. Future studies should aim to validate these fi ndings in much larger cohorts.