Effect of elevated hemoglobin A1c in diabetic patients on complication rates after Roux-en- Y gastric bypass

• Published in: Surgery for obesity and related diseases Vol. 9; no. 5; pp. 749 - 752
• Main Authors: Rawlins, Logan, M.D, Rawlins, Melissa P., M.P.A., P.A.-C, Brown, Carey C., M.D., F.A.C.S, Schumacher, David L., M.D., F.A.C.S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2013
• Subjects: Adult; Complication; Diabetes Mellitus, Type 2 - blood; Diabetic; Female; Gastric bypass; Gastric Bypass - methods; Gastroenterology and Hepatology; Glycated hemoglobin; Glycated Hemoglobin A - analysis; HbA1c; Hemoglobin A1c; Humans; Infection; Laparoscopic; Leak; Male; Obesity, Morbid - blood; Obesity, Morbid - surgery; Postoperative Complications; Retrospective Studies; Stenosis; Surgery; Treatment Outcome; Wound Healing; Infection; Hemoglobin A1c; Diabetic; Gastric bypass; Leak; Stenosis; Complication; Glycated hemoglobin; Laparoscopic; HbA1c
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2012.06.011

Abstract Background Little is known regarding the effect of chronic hyperglycemia, expressed by glycated hemoglobin, on the healing-related complication rates in Roux-en- Y gastric bypass (RYGB). Methods We retrospectively examined the rate of complications in patients with type 2 diabetes mellitus undergoing RYGB according to the preoperative glycated hemoglobin (HbA1c) level, focusing specifically on the complications related to wound healing (i.e., anastomotic leak, stomal stenosis, and wound infection). Two groups were formed separating those with HbA1c values >7 and <7 g/dL. All patients were taking oral antiglycemic medications or insulin to control their blood glucose levels. Results A total of 342 patients with type 2 diabetes mellitus underwent laparoscopic RYGB during a 3-year period (2008–2011). Of the 342 patients, 170 had elevated HbA1c values >7 g/dL (average 9.0) preoperatively, of which there were 4 superficial surgical site infections and 1 stomal stenosis, but no anastomotic leaks. Of the remaining 172 diabetic patients whose HbA1c level was <7 g/dL preoperatively (average 6.0 g/dL), 2 superficial surgical site infections, 2 stomal stenoses, and, again, no anastomotic leaks. No difference was seen in the combined complication rates between the 2 groups (2.9% versus 2.3%, P = .50). Conclusion In the present study, an elevated HbA1c >7 g/dL in patients with type 2 diabetes mellitus did not convey increased complication rates after RYGB.