HbA1C is not directly associated with complications of bariatric surgery

Abstract

Introduction: Bariatric surgery is effective therapy for weight loss and diabetes control. While patients with poorly controlled type 2 diabetes (T2D) experience significant benefit from bariatric surgery, the impact of hyperglycemia on perioperative risks is unclear. Objective: This study aims to investigate effect of elevated glycated hemoglobin (HbA1C) on perioperative risks for patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Settings: 117,644 patients undergoing RYGB or SG between the years of 2017 and 2018 in the United Stated were analyzed. Data was obtained using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Methods: Three commonly used cutoff levels of HbA1C were selected (6.5, 7.0, and 8.5). Complications were compared between groups of patients above and below each HbA1C level. Multivariable logistic regression models were used to account for confounders. Results: Without risk adjustment, HbA1C is indirectly associated with increased rates of surgical complications. However, after adjusting for underlying co-morbidities, HbA1C is not associated with overall complications, including 30 day readmissions, reoperations, reinterventions, or death at any HbA1C cutoff: 6.5 (odds ratio [OR] 1.041, P value = .219), 7.0 (OR 1.020, P value = .551), or 8.5 (OR 1.051, P value = .208). Conclusion: There is no direct relationship between HbA1C and early postoperative complications of SG and RYGB. Thus, optimizing preoperative HbA1C values alone, may not translate into decreased surgical complications of bariatric surgery. (Surg Obes Relat Dis 2020;17:271–275.) © 2020 American Society for Metabolic and Bariatric Surgery. All rights reserved.