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Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes—the Sunderland (UK) Experience

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Abstract

Purpose

UK guidelines recommend an HbA1c < 8.5% prior to elective surgery. Optimisation of pre-operative glycaemic control can be often difficult. Aim to correlate the effect of pre-operative HbA1c on the peri-operative complication rates and whether elective bariatric surgery should be delayed in poorly controlled diabetics.

Material and Methods

Retrospective data of consecutive patients who underwent laparoscopic Roux-en-Y gastric bypass, one-anastomosis gastric bypass and laparoscopic sleeve gastrectomy during January 2014 and April 2018. Patients were categorised into group 1, non-diabetics with an HbA1c < 6.5%; group 2, well-controlled diabetics with HbA1c between 6.5 and 8.4%; and group 3, poorly controlled diabetics with HbA1c ≥ 8.5%. Primary outcome was peri-operative complication rates.

Results

Group 1 (n = 978), 81.8% female, median (i.q.r.) age 44.0 (34–52) years, median (i.q.r.) BMI 42.0 (38.7–46.7); group 2 (n = 350), 66.3% female, age 51.0 (45–59) years, BMI 41.8 (37.5–46.5); and group 3 (n = 90), 60% female, age 52.0 (45–56) years and BMI 41.4(36.9–44.8). Early complication rates in each group were low, 1.0% vs 1.7% vs 1.1% (p = 0.592). Mean length of stay was 2 days across the groups (p > 0.05). There was no difference in 30-day re-admission rates between groups 2.8%, 2.9% and 3.3% (p = 0.983). At 6 months and 1 year, there was sustained and equal reduction in HbA1c in all groups (p < 0.05).

Conclusion

Patients undergoing metabolic surgery for poorly controlled diabetes achieve non-inferior peri-operative outcomes. Hence, delaying metabolic surgery in an attempt to optimise diabetic control is not justifiable.

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Acknowledgements

The authors would like to specially acknowledge and thank Bariatric Dietitians and Bariatric Nurse Specialists for their dedication and relentless efforts to achieve seamless patient care. They have been instrumental in collection and up keep of the department’s data registry.

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Authors and Affiliations

  1. Department of Upper GI and Bariatric Surgery, Sunderland Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK

    Nehemiah Samuel, Abdalla Mustafa, Helen Hawkins, Nicholas Wei, Maureen Boyle, Nimantha De Alwis, Peter Small, Kamal Mahawar & William Carr

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  1. Nehemiah Samuel
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  2. Abdalla Mustafa
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  3. Helen Hawkins
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  4. Nicholas Wei
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  6. Nimantha De Alwis
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  7. Peter Small
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  8. Kamal Mahawar
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  9. William Carr
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Corresponding author

Correspondence to Abdalla Mustafa.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study, formal consent does not apply.

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The authors declare no competing interests.

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Key Points

• Patients undergoing bariatric/metabolic surgery for poorly controlled diabetes can achieve comparable peri-operative outcomes as patients with optimal diabetes control.

• Post-operative diabetic control may be a better predictor of patient outcomes than pre-operative diabetic control.

• Delaying bariatric/metabolic surgery to optimise diabetic control in refractory cases may not be justifiable.

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IFFSO 2019, Madrid, Spain.

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Samuel, N., Mustafa, A., Hawkins, H. et al. Influence of Pre-operative HbA1c on Bariatric Surgery Outcomes—the Sunderland (UK) Experience. OBES SURG 32, 42–47 (2022). https://doi.org/10.1007/s11695-021-05741-y

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  • DOI: https://doi.org/10.1007/s11695-021-05741-y

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