Journal article
Optimizing Bariatric Surgery outcomes: the impact of preoperative elevated hemoglobin A1c levels on composite perioperative outcome measures
Surgical endoscopy, Vol.35(8), pp.4618-4623
2021
DOI: 10.1007/s00464-020-07887-9
PMCID: PMC8823948
PMID: 32789589
Abstract
Introduction
The use of bariatric surgery in the management of obesity and its related morbidity has significantly increased in the US over the past decade. There is a lack of data on the impact of optimal preoperative glycemic control on the morbidity and mortality following bariatric surgery. The aim of this study was to analyze the impact of hemoglobin (Hb) A1c > 7 on outcomes among patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).
Methods
Data were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (2017) and limited to patients undergoing an elective laparoscopic RYGB or SG. Multivariable logistic regression was conducted to adjust for other preoperative variables.
Results
A total number of 31,060 (69.3%) patients underwent SG, while 13,754 (30.7%) received RYGB. Patients who were older, male, non-Hispanic, smokers, and those with a higher American Society of Anesthesiologist Classification (ASA) score were more likely to have elevated HbA1c levels. Compared to individuals with normal HbA1c levels, patients with elevated levels had no significant difference in mortality (
p
= 0.902) but did have a difference in composite morbidity and mortality (
p
< 0.001). On multivariable analysis, elevated HbA1c, older age, increasing body mass index (BMI), elevated creatinine, longer operations, African American race, receiving RYGB, and having a trainee as surgical assistant were found to increase the odds of having an adverse outcome. No significant difference was found within smoking status, sex, ASA Classification, robotic vs laparoscopic, or if a second attending surgeon was assisting.
Conclusions
HbA1c levels and presence of trainees in the OR are modifiable preoperative risk factors for adverse events following bariatric surgery. Improving preoperative glycemic control may be an effective and achievable quality improvement measure.
Details
- Title: Subtitle
- Optimizing Bariatric Surgery outcomes: the impact of preoperative elevated hemoglobin A1c levels on composite perioperative outcome measures
- Creators
- Alexander Hart - University of IowaPaolo Goffredo - University of Iowa Hospitals and ClinicsRory Carroll - University of IowaRyan Lehmann - University of IowaPeter Nau - University of IowaJessica Smith - University of IowaSajida Ahad - University of IowaWei Bao - University of IowaImran Hassan - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.35(8), pp.4618-4623
- Publisher
- Springer US
- DOI
- 10.1007/s00464-020-07887-9
- PMID
- 32789589
- PMCID
- PMC8823948
- ISSN
- 0930-2794
- eISSN
- 1432-2218
- Language
- English
- Date published
- 2021
- Academic Unit
- Pharmaceutical Sciences and Experimental Therapeutics; Surgery
- Record Identifier
- 9984322827502771
Metrics
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