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Is glycosylated hemoglobin A1c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass?
Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Lindesberg Hospital, Lindesberg, Sweden .ORCID iD: 0000-0003-4958-1611
Örebro University Hospital. Department of Surgery.
Örebro University Hospital. Department of Surgery.
2014 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 10, no 5, p. 801-805Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Glycosylated hemoglobin A1 c (HbA1 c) has been described as a risk factor for adverse outcome after cardiovascular and colorectal surgery, but not for obese patients undergoing bariatric surgery. The objective of this study was to see if there is an association between HbA1 c and adverse outcome in laparoscopic gastric bypass surgery.

METHODS: From the Scandinavian Obesity Surgery Registry we identified 12,850 patients, without treatment for diabetes and operated with laparoscopic gastric bypass between January 1, 2010 and September 30, 2012, and where a baseline HbA1 c value was registered. Preoperative data were compared with data from a 30-day follow-up. Severe complications were defined according to the Clavien-Dindo-Scale as Grade 3 b or higher.

RESULTS: HbA1 c levels below 5.7 % were associated with a lower incidence of severe complications (2.7 %) than higher levels (HbA1 c 5.7-6.49% incidence 3.5%, P = .015; HbA1 c>6.5%, incidence 4.5%, P = .012). After multivariate analysis with patient-specific confounders the difference remained significant (HbA1 c 5.7-6.49% adjusted P = .046; HbA1 c>6.5% adjusted P = .023) CONCLUSION: Elevated HbA1 c levels in patients without pharmacologic treatment for diabetes undergoing laparoscopic gastric bypass surgery is associated with an increased risk for severe complications during the first 30 postoperative days. This is the case, even at levels not regarded as diagnostic for diabetes.

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 10, no 5, p. 801-805
Keywords [en]
hemoglobin A1c, Nondiabetic, Postoperative complications, laparoscopic gastric bypass, risk factor
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-40585DOI: 10.1016/j.soard.2014.05.005ISI: 000344719200009PubMedID: 25304835Scopus ID: 2-s2.0-84928828943OAI: oai:DiVA.org:oru-40585DiVA, id: diva2:780744
Conference
Obesity week, Atlanta, Georgia, USA, November 11-16, 2013
Projects
Preventing complications in bariatric surgery
Note

Sponsor:

Orebro County Council

Available from: 2015-01-15 Created: 2015-01-08 Last updated: 2018-04-16Bibliographically approved
In thesis
1. Preventing complications in bariatric surgery
Open this publication in new window or tab >>Preventing complications in bariatric surgery
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is a major public health problem. Bariatric surgery is currently the only available treatment that offers sufficient weight-loss and metabolic benefits over time. Although bariatric surgery is considered safe now, serious complications still occur. The aim of this thesis was to identify factors associated with an increased risk for postoperative complication after laparoscopic gastric bypass surgery.

Study I included patients operated with laparoscopic gastric bypass surgery in Sweden from May 2007 until September 2012. The risk for serious complication was low (3.4%). Suffering an intraoperative adverse event or conversion of the operation to open surgery were the strongest risk factors for postoperative complication. The annual operative volume and experience of the procedure at the institution were also important risk factors. Patient-specific risk factors appeared to be less important although age was associated with an increased risk. In Study II, a raised glycated haemoglobin A1c (HbA1c) was evaluated as a risk factor for serious postoperative complications in non-diabetics. A higher incidence of serious postoperative complications was seen with elevated HbA1c values, even at levels classified as ‘‘pre-diabetic’’.

Study III was a multicentre, randomised clinical trial (RCT). 2507 patients planned for laparoscopic gastric bypass surgery were randomised to either mesenteric defects closure or non-closure. Closure of the mesenteric defects reduced the rate of reoperation for small bowel obstruction from 10.2% to 5.5% at 3 years after surgery. A small increase in the rate of serious postoperative complication within the first 30 days was seen with mesenteric defects closure. This relatively small increase in risk was however outweighed by the marked reduction of later reoperations for small bowel obstruction.

Study IV was a comparison between study III and an observational study on the same population under the same period of time. Although the observational study reached the same conlusion as the RCT, the efficacy of mesenteric defects closure was less pronounced. Observational studies may thus be an alternative to RCTs under situations when RCTs are not feasible. The efficacy may however be underestimated.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 103
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 147
Keywords
postoperative complications, bariatric surgery, morbid obesity, risk factor, randomised clinical trial, haemoglobin A1c, prevention
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-50649 (URN)978-91-7529-149-9 (ISBN)
Public defence
2016-10-07, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2016-06-09 Created: 2016-06-09 Last updated: 2017-10-18Bibliographically approved

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