Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery

• Published in: Journal of the American College of Surgeons Vol. 221; no. 4; pp. 854 - 861.e1
• Main Authors: Goodenough, Christopher J., MD, MPH, Liang, Mike K., MD, Nguyen, Mylan T., MPH, Nguyen, Duyen H., MPH, Holihan, Julie L., MD, Alawadi, Zeinab M., MD, Roth, John S., MD, FACS, Wray, Curtis J., MD, FACS, Ko, Tien C., MD, FACS, Kao, Lillian S., MD, MS, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2015
• Subjects: Blood Glucose - metabolism; Diabetes Mellitus - blood; Elective Surgical Procedures; Female; Follow-Up Studies; Glycated Hemoglobin A - metabolism; Humans; Laparotomy; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Period; Preoperative Period; Prospective Studies; Risk Assessment - methods; Risk Factors; Surgery; United States - epidemiology; DM; American Society of Anesthesiologists; diabetes mellitus; AIC; hemoglobin A1c; HbA1c; Akaike Information Criterion; ASA
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2015.07.013

Background Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. Study Design A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Results Among 438 patients who had a measured HbA1c, 96 (21.9%) experienced a major complication. On multivariate analysis, HbA1c ≥6.5% (odds ratio = 1.95; 95% CI, 1.17–3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p < 0.01). Predicted probabilities demonstrated that both HbA1c and glucose together contributed to major complications; and HbA1c impacted the ability to achieve optimal perioperative glucose control. Patients with a BMI >30 kg/m2 , history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥6.5%. Conclusions Elevated HbA1c ≥6.5% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes.