Preoperative Glycosylated Haemoglobin (HbA1c) Does Impact on Postoperative Complications in Patients Undergoing Gastrointestinal and Hepatobiliary Surgery

Sivesh K Kamarajah ； Amirul Adlan ； Behrad Barmayehvar ； Mustafa Sowida ； Christina Reihill ； Parvez Ellahee

《Asian Journal of Anesthesiology》 56卷3期 (2018/09) Pp. 83-91

https://doi.org/10.6859/aja.201809_56(3).0003

摘要

Introduction: The impact of preoperative glycated haemoglobin (HbA1c) in patients undergoing gastrointestinal and hepatobiliary surgery is unclear as data is limited. Methods: Patients undergoing gastrointestinal surgery attending pre-assessment screening (PAS) clinics from August to September 2016 at the Queen Elizabeth Hospital Birmingham (QEHB) were identified. Outcome measure was postoperative complications as defined by the Clavien-Dindo classification system. Results: In this study, 381 patients were included, of which 48% (181/381) had HbA1c measured. Of these, 27% (49/181) had a HbA1c ≥ 48 mmol/mol. Overall complications were 14% and major complication rates were 3% (11/381). In unadjusted models, patients with HbA1c ≥ 48 mmol/mol had significantly higher rates of overall complications (odds ratio [OR] = 2.82, 95% confidence interval [CI] = 1.22-6.49; p = 0.015). In adjusted models, only surgical grade was predictive of overall complications. In patients undergoing major surgery (n = 93), there were significantly higher rates of overall complications in patients with HbA1c ≥ 48 mmol/mol as compared to those with HbA1c ＜ 48 mmol/mol (63% vs. 46%, p = 0.043). Conclusion: Utility of HbA1c to stratify patients undergoing gastrointestinal and hepatobiliary surgery into high-risk clinics is limited from this study. Future studies should aim to validate these findings in much larger cohorts.

關鍵字

HbA1c ； outcomes ； surgery ； post-op complications