The Effects of Preoperative Glycaemic Control (HbA1c) on Bariatric and Metabolic Surgery Outcomes: Data from a Tertiary-Referral Bariatric Centre in the UK

Wilmington, Rebekah; Abuawwad, Mahmoud; Holt, Guy; Anderson, Robyn; Aldafas, Rami; Awad, Sherif; Idris, Iskandar

Abstract

Background: Current recommendations advocate the achievement of an optimal glucose control (HbA1c < 69mmol/mol) prior to elective surgery to reduce risks of peri- and post-operative complications, but the relevance for this glycaemic threshold prior to Bariatric Metabolic Surgery (BMS) following a specialist weight management programme remains unclear. Methods: We undertook a retrospective cohort study of patients with type 2 diabetes mellitus (T2DM) who underwent BMS over a 6-year period (2016–2022) at a regional tertiary referral following completion of a specialist multidisciplinary weight management. Post-operative outcomes of interest included 30-day mortality, readmission rates, need for Intensive Care Unit (ICU) care and hospital length of stay (LOS) and were assessed according to HbA1c cut-off values of < 69 (N = 202) and > 69mmol/mol (N = 67) as well as a continuous variable. Results: A total of 269 patients with T2D were included in this study. Patients underwent primary Roux en-Y gastric bypass (RYGB, n = 136), Sleeve Gastrectomy (SG, n = 124), insertion of gastric band (n = 4) or one-anastomosis gastric bypass (OAGB, n = 4). No significant differences in the rates of complications were observed between the two groups of pre-operative HbA1c cut-off values. No HbA1c threshold was observed for glycaemic control that would affect the peri- and post-operative complications following BMS. Conclusions: We observed no associations between pre-operative HbA1C values and the risk of peri- and post-operative complications. In the context of a specialist multidisciplinary weight management programme, optimising pre-operative HbA1C to a recommended target value prior to BMS may not translate into reduced risks of peri- and post-operative complications.

• Journal Article Type: Article
• Acceptance Date: Nov 14, 2023
• Online Publication Date: Jan 15, 2024
• Publication Date: 2024-03
• Deposit Date: Nov 16, 2023
• Publicly Available Date: Jan 16, 2025
• Journal: Obesity Surgery
• Print ISSN: 0960-8923
• Electronic ISSN: 1708-0428
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 34
• Pages: 850-854
• DOI: https://doi.org/10.1007/s11695-023-06964-x
• Keywords: Bariatric surgery; Type 2 diabetes; Glycated Haemoglobin; HbA1c; peri- operative; post operative; complications; mortality; Intensive care; Length of stay
• Public URL: https://nottingham-repository.worktribe.com/output/27375315
• Publisher URL: https://link.springer.com/article/10.1007/s11695-023-06964-x
• Additional Information: Received: 27 September 2023; Revised: 14 November 2023; Accepted: 14 November 2023; First Online: 15 January 2024; : ; : Retrospective study. For this type of study, formal consent is not required.; : This was a retrospective study. Informed consent does not apply.; : The authors declare no competing interests.