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Open Access 01-09-2019 | Sleeve Gastrectomy | Original Contributions

Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy—a Cohort Study

Authors: Michał Wysocki, Maciej Walędziak, Hady Razak Hady, Mikołaj Czerniawski, Monika Proczko-Stepaniak, Michał Szymański, Natalia Dowgiałło-Wnukiewicz, Piotr Kozera, Jacek Szeliga, Michał Orłowski, Michał Pędziwiatr, Magdalena Szopa, Andrzej Budzyński, Piotr Major

Published in: Obesity Surgery | Issue 9/2019

Abstract

Introduction

Available clinical data on the influence of baseline HbA_1c postoperative morbidity and readmission after laparoscopic sleeve gastrectomy is scarce. This prompted us to conduct a multicenter retrospective study evaluating the influence of chronic hyperglycemia on postoperative course among patients undergoing laparoscopic sleeve gastrectomy (SG). We aimed to investigate the influence of baseline HbA_1c levels on postoperative outcomes in patients after SG.

Material and Methods

We conducted a multicenter retrospective cohort study of consecutive patients who underwent SG from March 2017 to March 2018 in seven referral centers for bariatric surgery. Exclusion criteria were revision surgeries, different bariatric interventions, SG combined with other procedures, and lack of necessary data. Patients were divided into three groups depending on their preoperative glycated hemoglobin level (HbA_1c) < 5.7%, 5.7–6.4%, and ≥ 6.5%. Primary endpoints were influence of HbA_1c on early and late postoperative morbidity, impact on prolonged length of hospital stay (LOS), and readmission rate.

Results

The HbA_1c < 5.7% group comprised 842 (49%) patients, HbA_1c 5.7–6.4% comprised 587 (34%), and HbA_1c ≥ 6.5% comprised 289 (17%). Overall morbidity was 6.23%; this did not differ among groups (p = 0.571). Three patients died postoperatively. Late postoperative morbidity was comparable among groups (p = 0.312). The ratio of prolonged LOS and readmission did not differ among groups (p = 0.363 and 0.571). ROC analysis revealed that HbA_1c > 7.3% increased OR for hospital readmission (p = 0.007).

Conclusion

Preoperative HbA_1c does not affect postoperative morbidity and prolonged LOS after SG. Patients with HbA_1c > 7.3% have an increased chance of hospital readmission.

Finnerty CC, Mabvuure NT, Ali A, et al. The surgically induced stress response. JPEN J Parenter Enteral Nutr [Internet]. 2013;37:21S–9S.CrossRef

Valentine NA, Alhawassi TM, Roberts GW, et al. Detecting undiagnosed diabetes using glycated haemoglobin: an automated screening test in hospitalised patients. Med J Aust. 2011;194:160–4.CrossRefPubMed

American Diabetes Association AD. 3. Comprehensive medical evaluation and assessment of comorbidities. Diabetes Care [Internet]. 2017;40:S25–32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27979890 CrossRef

Carson JL, Scholz PM, Chen AY, et al. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002;40:418–23.CrossRefPubMed

Thourani VH, Weintraub WS, Stein B, et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg [Internet]. 1999;67:1045–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10320249 CrossRef

Little SA, Jarnagin WR, DeMatteo RP, et al. Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer. J Gastrointest Surg. 2002;6:88–94.CrossRefPubMed

Hughes K, Jackson JD, Prendergast TI, et al. Diabetes mellitus is not associated with major morbidity following open abdominal aortic aneurysm repair. J Surg Res [Internet]. 2013;184:751–4. Available from: http://www.sciencedirect.com/science/article/pii/S0022480413004034 CrossRef

Yeh C-C, Liao C-C, Chang Y-C, et al. Adverse outcomes after noncardiac surgery in patients with diabetes: a nationwide population-based retrospective cohort study. Diabetes care [Internet]. 2013;36:3216–21. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3781492&tool=pmcentrez&rendertype=abstract CrossRefPubMedPubMedCentral

Ata A, Valerian BT, Lee EC, et al. The effect of diabetes mellitus on surgical site infections after colorectal and noncolorectal general surgical operations. Am Surg. 2010;76:697–702.PubMed

10.

Krolikowska M, Kataja M, Poyhia R, et al. Mortality in diabetic patients undergoing non-cardiac surgery: a 7-year follow-up study. Acta Anaesthesiol Scand. 2009;53:749–58.CrossRefPubMed

11.

Greci LS, Kailasam M, Malkani S, et al. Utility of HbA1c levels for diabetes case finding in hospitalized patients with hyperglycemia. Diabetes Care [Internet]. 2003;26:1064–8. Available from: http://care.diabetesjournals.org/content/26/4/1064.full-text.pdf CrossRef

12.

Wysocki M, Szopa M, Stefura T, Dudek A, Torbicz G, Gajewska N, et al. Continuous glucose monitoring in bariatric patients undergoing laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Obes Surg 2018;

13.

The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care [Internet]. 2009;32:1327–34. Available from: http://care.diabetesjournals.org/cgi/doi/10.2337/dc09-9033 CrossRef

14.

American Diabetes Association, Of D, Mellitus D, American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care [Internet]. 2014;37:81–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24357215 CrossRef

15.

Rollins KE, Varadhan KK, Dhatariya K, et al. Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus. Clin Nutr [Internet]. 2015;35:1–10. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0261561415000825

16.

Chuah LL, Miras AD, Papamargaritis D, et al. Impact of perioperative management of glycemia in severely obese diabetic patients undergoing gastric bypass surgery. Surg Obes Relat Dis. 2015;11:578–84.CrossRefPubMed

17.

Cruijsen M, Koehestani P, Huttjes S, et al. Perioperative glycaemic control in insulin-treated type 2 diabetes patients undergoing gastric bypass surgery. Neth J Med. 2014;72:202–9.PubMed

18.

Perna M, Romagnuolo J, Morgan K, et al. Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity. Surg Obes Relat Dis. 2012;8:685–90.CrossRefPubMed

19.

Rawlins L, Rawlins MP, Brown CC, et al. Effect of elevated hemoglobin A1c in diabetic patients on complication rates after Roux-en-Y gastric bypass. Surg Obes Relat Dis [Internet]. 2013;9:749–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22884300 CrossRef

20.

Zaman JA, Shah N, Leverson GE, et al. The effects of optimal perioperative glucose control on morbidly obese patients undergoing bariatric surgery. Surg Endosc [Internet]. 2017;31:1407–13. Available from: http://link.springer.com/10.1007/s00464-016-5129-x CrossRef

21.

Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies [Internet]. Lancet. 2007;370:1453–7. Available from: http://onlinelibrary.wiley.com/o/cochrane/clcmr/articles/CMR-11777/frame.html.CrossRef

22.

Budzyński A, Major P, Głuszek S, et al. Polskie rekomendacje w zakresie chirurgii bariatrycznej i metabolicznej. Med Prakt – Chir. 2016;6:13–25.

23.

Diabetes Poland. Guidelines on the management of diabetic patients. A position of diabetes Poland. Clin Diabetol. 2017;6:1–80.

24.

Nathan D, Buse J, Davidson M, et al. Medical management of hyperglycemia in type 2 diabetes : a consensus algorithm. Diabetes care [Internet]. 2009;32:193–203. Available from: https://media-proquest-com.ezproxy.uwe.ac.uk/media/pq/classic/doc/1124917791/fmt/pi/rep/NONE?cit%3Aauth=Nathan%2C+David+M%3BBuse%2C+John+B%3BDavidson%2C+Mayer+B%3BHeine%2C+Robert+J%3Bet+al&cit%3Atitle=Management+of+Hyperglycemia+in+Type+2+Diabetes%3A+A+Co CrossRef

25.

Major P, Matłok M, Pędziwiatr M, et al. Changes in levels of selected incretins and appetite-controlling hormones following surgical treatment for morbid obesity. Videosurgery other Miniinvasive Tech [Internet]. 2015;10:458–65. https://doi.org/10.5114/wiitm.2015.54003.CrossRef

26.

Wroblewski E, Swidnicka-Siergiejko A, Hady HR, et al. Variation in blood levels of hormones in obese patients following weight reduction induced by endoscopic and surgical bariatric therapies. Cytokine. 2016;77:56–62.CrossRefPubMed

27.

Title: Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy—a Cohort Study
Authors: Michał Wysocki
Maciej Walędziak
Hady Razak Hady
Mikołaj Czerniawski
Monika Proczko-Stepaniak
Michał Szymański
Natalia Dowgiałło-Wnukiewicz
Piotr Kozera
Jacek Szeliga
Michał Orłowski
Michał Pędziwiatr
Magdalena Szopa
Andrzej Budzyński
Piotr Major
Publication date: 01-09-2019
Publisher: Springer US
Keywords: Sleeve Gastrectomy
Type 2 Diabetes
Published in: Obesity Surgery / Issue 9/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-019-03936-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Type 2 Diabetes Mellitus and Preoperative HbA1c Level Have no Consequence on Outcomes after Laparoscopic Sleeve Gastrectomy—a Cohort Study

Abstract

Introduction

Material and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Material and Methods

Results

Conclusion

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