Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic review

IF 3.2 3区医学 Q2 ENDOCRINOLOGY & METABOLISM Diabetic Medicine Pub Date : 2024-06-10 DOI:10.1111/dme.15380

Abby Yu, Quynh Truong, Karen Whitfield, Andrew Hale, Meng-Wong Taing, Natalie Barker, Michael D’Emden

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Abstract

Aims

Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A_1c (HbA_1c) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA_1c levels on postoperative outcomes in adults who had undergone major noncardiac surgery.

Methods

We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case–control studies) which measured HbA_1c within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA_1c as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946).

Results

Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA_1c levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA_1c was associated with increased odds of these complications. No association with reoperations and 30-day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism.

Conclusions

Current evidence suggested that higher preoperative HbA_1c levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. Further high-quality studies would be needed to quantify the risks posed and determine whether early intervention improves outcomes.

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接受非心脏大手术的成人术前血红蛋白 A1c 水平对术后结果的影响：系统综述。

目的：众所周知，糖尿病会增加大手术后的发病率和死亡率。然而，关于术前血红蛋白 A1c（HbA1c）水平升高是否与非心脏大手术后的不良预后有关，文献的说法不一。我们旨在研究术前 HbA1c 水平的增高对接受大型非心脏手术的成人术后预后的影响：我们系统检索了 PubMed、EMBASE 和 Cochrane Library 数据库中 2012 年 1 月至 2023 年 7 月间发表的符合条件的研究。纳入的研究包括随机对照试验和观察性研究（队列和病例对照研究），这些研究在手术前 6 个月内测量 HbA1c，并对至少三个增量亚组的结果进行比较，或将 HbA1c 作为连续变量进行分析。系统综述方案已在 PROSPERO 注册（CRD42023391946）：结果：共纳入了 20 项调查多种手术类型结果的观察性研究。术前 HbA1c 水平越高，术后总体并发症、术后急性肾损伤、吻合口漏、手术部位感染和住院时间延长的几率越大。术前 HbA1c 每增加 1%，这些并发症发生的几率就会增加。未发现与再次手术和 30 天死亡率有关。在综合主要并发症、围术期心血管事件、再住院率、术后肺炎和全身血栓栓塞方面，文献的研究结果差异很大：目前的证据表明，术前 HbA1c 水平越高，接受非心脏大手术的成人出现术后并发症和住院时间延长的几率就越大。需要进一步开展高质量的研究，以量化风险并确定早期干预是否能改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”