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Association of Preoperative Glycosylated Hemoglobin Level with 30-Day Outcomes Following Laparoscopic Roux-en-Y Gastric Bypass: an Analysis of the ACS-MBSAQIP Database

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Abstract

Purpose

Elevated glycosylated hemoglobin (HbA1c) levels have been associated with increased morbidity and mortality following several cardiac, colorectal, orthopedic, and vascular surgery operations. The purpose of this study was to determine if there is a HgA1c cut-point that can be used in patients undergoing laparoscopic Roux-en-Y gastric bypass to decrease the risk of 30-day wound events and additional 30-day morbidity and mortality.

Materials and Methods

All patients undergoing first-time, elective Roux-en-Y gastric bypass in 2017 and 2018 with a diagnosis of diabetes mellitus (DM) and a preoperative HbA1c level were identified within the American College of Surgeons Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (ACS-MBSAQIP) database. The association of preoperative HbA1c levels with 30-day morbidity and mortality was investigated.

Results

A total of 13,806 patients met inclusion criteria. Two natural HbA1c inflection points for composite wound events, including superficial, deep, and organ space surgical site infections (SSI) and wound dehiscence, were found. A HbA1c level of ≤ 6.5% was associated with a decreased odds of experiencing the composite 30-day wound event outcome while a HbA1c level of > 8.6% was associated with an increased odds of experiencing the composite 30-day wound event outcome. The differences in the incidence of the 30-day composite wound event outcomes were driven primarily by superficial and organ space SSI, including anastomotic leaks.

Conclusion

Patients with DM being evaluated for RYGB surgery with a HbA1c level > 8.6% are at an increased risk for 30-day wound events, including superficial and organ space SSI.

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Authors and Affiliations

  1. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198-3280, USA

    Ivy N. Haskins, Tiffany N. Tanner, Vishal Kothari & Corrigan L. McBride

  2. Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Hope T. Jackson, Andrew D. Sparks & Khashayar Vaziri

  3. Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Timothy M. Farrell

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  1. Ivy N. Haskins
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  2. Hope T. Jackson
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Correspondence to Ivy N. Haskins.

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Conflict of Interest

Author 1 receives royalty from UpToDate, Inc. which is not related to this work. The remaining authors have no conflict of interest to disclose, either directly related or unrelated to this work.

ACS-MBSAQIP Disclaimer Statement

The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP) and the hospitals participating in the ACS-MBSAQIP are the source of the date used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Key Points

• Obesity and diabetes mellitus co-occur in many patients undergoing evaluation for bariatric surgery.

• Wound events, including organ space infection, are a common source of morbidity following bariatric surgery.

• Diabetic patients with a HgA1c level > 8.6% are at an increased risk for 30-day wound events following laparoscopic Roux-en-Y gastric bypass.

• Consideration should be given to additional preoperative optimization for diabetic patients with a preoperative HgA1c level > 8.6% prior to undergoing laparoscopic Roux-en-Y gastric bypass.

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Haskins, I.N., Jackson, H.T., Sparks, A.D. et al. Association of Preoperative Glycosylated Hemoglobin Level with 30-Day Outcomes Following Laparoscopic Roux-en-Y Gastric Bypass: an Analysis of the ACS-MBSAQIP Database. OBES SURG 32, 3611–3618 (2022). https://doi.org/10.1007/s11695-022-06243-1

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  • DOI: https://doi.org/10.1007/s11695-022-06243-1

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