Michał Wysocki1,2, Maciej Walędziak3, Hady Razak Hady4, Mikołaj Czerniawski4, Monika Proczko-Stepaniak5, Michał Szymański5, Natalia Dowgiałło-Wnukiewicz6, Piotr Kozera6, Jacek Szeliga7, Michał Orłowski8, Michał Pędziwiatr1,2, Magdalena Szopa9, Andrzej Budzyński1,2, Piotr Major10,11. 1. 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland. 2. Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland. 3. Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland. 4. First Clinical Department of General and Endocrine Surgery, Medical University of Bialystok, Bialystok, Poland. 5. Chair and Clinic of General, Minimally Invasive and Elderly Surgery, University of Warmia & Mazury, Olsztyn, Poland. 6. Department of General, Gastroenterological, and Oncological Surgery Collegium Medicum, Nicolaus Copernicus University, Torun, Poland. 7. General and Vascular Surgery Department, Ceynowa Hospital, Wejherowo, Poland. 8. Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland. 9. Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland. 10. 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland. piotr.major@uj.edu.pl. 11. Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland. piotr.major@uj.edu.pl.
Abstract
INTRODUCTION: Available clinical data on the influence of baseline HbA1c postoperative morbidity and readmission after laparoscopic sleeve gastrectomy is scarce. This prompted us to conduct a multicenter retrospective study evaluating the influence of chronic hyperglycemia on postoperative course among patients undergoing laparoscopic sleeve gastrectomy (SG). We aimed to investigate the influence of baseline HbA1c levels on postoperative outcomes in patients after SG. MATERIAL AND METHODS: We conducted a multicenter retrospective cohort study of consecutive patients who underwent SG from March 2017 to March 2018 in seven referral centers for bariatric surgery. Exclusion criteria were revision surgeries, different bariatric interventions, SG combined with other procedures, and lack of necessary data. Patients were divided into three groups depending on their preoperative glycated hemoglobin level (HbA1c) < 5.7%, 5.7-6.4%, and ≥ 6.5%. Primary endpoints were influence of HbA1c on early and late postoperative morbidity, impact on prolonged length of hospital stay (LOS), and readmission rate. RESULTS: The HbA1c < 5.7% group comprised 842 (49%) patients, HbA1c 5.7-6.4% comprised 587 (34%), and HbA1c ≥ 6.5% comprised 289 (17%). Overall morbidity was 6.23%; this did not differ among groups (p = 0.571). Three patients died postoperatively. Late postoperative morbidity was comparable among groups (p = 0.312). The ratio of prolonged LOS and readmission did not differ among groups (p = 0.363 and 0.571). ROC analysis revealed that HbA1c > 7.3% increased OR for hospital readmission (p = 0.007). CONCLUSION: Preoperative HbA1c does not affect postoperative morbidity and prolonged LOS after SG. Patients with HbA1c > 7.3% have an increased chance of hospital readmission.
INTRODUCTION: Available clinical data on the influence of baseline HbA1c postoperative morbidity and readmission after laparoscopic sleeve gastrectomy is scarce. This prompted us to conduct a multicenter retrospective study evaluating the influence of chronic hyperglycemia on postoperative course among patients undergoing laparoscopic sleeve gastrectomy (SG). We aimed to investigate the influence of baseline HbA1c levels on postoperative outcomes in patients after SG. MATERIAL AND METHODS: We conducted a multicenter retrospective cohort study of consecutive patients who underwent SG from March 2017 to March 2018 in seven referral centers for bariatric surgery. Exclusion criteria were revision surgeries, different bariatric interventions, SG combined with other procedures, and lack of necessary data. Patients were divided into three groups depending on their preoperative glycated hemoglobin level (HbA1c) < 5.7%, 5.7-6.4%, and ≥ 6.5%. Primary endpoints were influence of HbA1c on early and late postoperative morbidity, impact on prolonged length of hospital stay (LOS), and readmission rate. RESULTS: The HbA1c < 5.7% group comprised 842 (49%) patients, HbA1c 5.7-6.4% comprised 587 (34%), and HbA1c ≥ 6.5% comprised 289 (17%). Overall morbidity was 6.23%; this did not differ among groups (p = 0.571). Three patientsdied postoperatively. Late postoperative morbidity was comparable among groups (p = 0.312). The ratio of prolonged LOS and readmission did not differ among groups (p = 0.363 and 0.571). ROC analysis revealed that HbA1c > 7.3% increased OR for hospital readmission (p = 0.007). CONCLUSION: Preoperative HbA1c does not affect postoperative morbidity and prolonged LOS after SG. Patients with HbA1c > 7.3% have an increased chance of hospital readmission.
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