Background

Preoperative glycemia as reflected by out-of-range hemoglobin A1c (HbA1c) >8 has been linked to adverse outcomes. Since bariatric surgery improves glycemia, benefits may exist for patients with obesity and out-of-range diabetes.

Methods

Patients who underwent bariatric procedures at our MBSAQIP Center from February 2017-December 2018 with known diabetes and a preoperative HbA1c were divided into three groups: (A) HbA1c ≤6.5, (B) HbA1c 6.6-7.9, and (C) HbA1c ≥8. We compared: demographics, comorbidities, procedures, and outcomes (30-day, 60-day, 1-year). Protocolized inpatient glycemic management with insulin was utilized as necessary.

Results

Eight hundred eighty-three patients underwent bariatric procedures and 179 were included: Group A – 62 (35%), Group B – 61 (34%), and Group C – 56 (31%). Mean preoperative HbA1c was 5.8, 7.2, and 9.3, respectively. There were significantly more females in all groups (87%, 62%, and 64%, respectively, p=0.00396). Group A patients were significantly younger (45, 52, and 51 years, respectively, p=0.00126). There was no significant difference in mean BMI (42.9, 44.2, 43.1), modality (laparoscopic [65%, 74%, 71%], robotic [35%, 26%, 29%]) or procedure (sleeve gastrectomy [71%, 59%, 68%], Roux-en-Y gastric bypass [23%, 28%, 27%], band removal [6%, 10%, 5%]). Three 30-day SSIs occurred (Group A, n=1; Group B, n=2). There was no significant difference in 30-day (3, 3, 2), 60-day (0, 0, 2), or 1-year (1, 1, 1) events. One 30-day mortality occurred in Group B (opioid overdose).

Conclusions

Out-of-range HbA1c may not directly correlate to adverse outcomes after bariatric surgery. Clinical judgement in such cases is warranted.