Preoperative glycemic control and postoperative clinical outcomes in patients with type 2 diabetes mellitus undergoing bariatric surgery

Abstract

Background

The preoperative glycated hemoglobin (HbA1c) cutoff point for elective surgery in patients with type 2 diabetes mellitus (T2DM) remains unclear, as does its association with postoperative outcomes, especially in patients undergoing bariatric surgery.

Methods

We conducted a retrospective cohort study including patients with T2DM and an electronic record of HbA1c within the four months prior to surgery who underwent Roux-en-Y gastric bypass (RYGB) from August 2010 to May 2019. The primary outcome was postoperative hospital length of stay (LOS), and secondary outcomes included need for intensive care, clinical outcomes (pulmonary, cardiovascular, septic), and surgical wound complications. These outcomes were assessed using an HbA1c cutoff value of 7 %. Comparisons were made using the Mann–Whitney U test and a general linear model adjusting the primary outcome for confounders and for differences in baseline characteristics between groups.

Results

A total of 114 individuals were divided into two groups according to HbA1c: ≤7 % (N = 63) or > 7 % (N = 51). No differences were observed between the groups in terms of LOS (4 vs 5 days, p = 0.28) and clinical or operative wound complication rates. Alternative HbA1c cutoff points (7.5 %, 8 %, and 8.5 %) were also evaluated for LOS, with no change in results.

Conclusion

Bariatric surgery should not be postponed in patients with T2DM based on an HbA1c greater than 7 %, as LOS, clinical outcomes and operative wound complication rates are not worse in patients with poorer glucose control based on this criterion.