Perioperative Glycemic Control and Postoperative Complications in Patients Undergoing Emergency General Surgery: What is the role of HbA1c?.

Background: Plasma Hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). Methods: We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3-months before surgery were included. Patients were divided into two groups (HbA1c=6). Our primary outcome measures included in-hospital complications (major and minor complications), hospital and ICU LOS, and mortality. Secondary outcomes measures were 30-day complications, readmissions, and mortality. Multivariate and linear regressions were performed. Results: Of the 402 study patients, mean age was 61+/-12 years, 53% were females, and 63.8% were diabetics. Overall, 49% had an HbA1c>=6%; the mortality rate was 6%. Those with hypertension, history of coronary artery disease, and BMI>=30kg/m2 were more likely to have HbA1c>=6.0%. 7.9% patients experienced major complications. Patients with HbA1c>=6% had a higher complication rate (36% vs 11%, p=6.0% (OR: 2.9; p=200mg/dl (OR: 2.3; p=6.0% and post-op RBS>=200 had higher odds (OR: 4.2; p=6.0% and a post-op RBS>=200mg/dl have a 4 times higher risk of developing major complications after EGS. A pre-op HbA1c can stratify patients prone to develop post-op hyperglycemia, regardless of their pre-op RBS. Level of Evidence: Level III, prognostic. (C) 2017 Lippincott Williams & Wilkins, Inc.

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