Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery

Postoperative dysglycemia in elective non-diabetic surgical patients: a prospective observational study

“…27,28 Nevertheless, the current evidence is insufficient to recommend an upper limit of HbA1c prior to elective surgery, and the risks associated with poor glycemic control should be balanced against the necessity for surgery. The conclusions from Goodenough et al 2 show the importance of identifying both elevated HbA1c as well as postoperative hyperglycemia. Although there is a correlation between the two, the types of complications may differ.…”

“…1 Surgical patients with diabetes require greater use of healthcare resources and are at an increased risk of morbidity and mortality in the postoperative period. [2][3][4][5][6][7] This may be due to associated comorbidities, such as cardiovascular disease, but may also be more directly due to the presence of elevated blood glucose levels. 8 Studies have shown that hyperglycemia is common in both medical and surgical hospital inpatients.…”

“…19,20 Recent studies of abdominal surgery suggest that elevated HbA1c is associated with major cardiac complications, while hyperglycemia is more likely to be associated with SSI, emphasizing the importance of identifying both of these risk factors. 2,14 If this were indeed the case, widespread HbA1c screening and postoperative glucose testing would each identify different types of high-risk patients to target for intervention strategies. Nevertheless, more studies are needed to determine which patients should be screened and if the correlations between HbA1c and hyperglycemia are seen in diverse surgical populations.…”

Choosing wisely and preoperative hemoglobin A1c testing: what should it mean?

“…2,9 En revanche, en ce qui touche aux chirurgies en milieu hospitalier, l'épidémiologie de cette maladie est plus favorable au dépistage et les liens entre des taux élevés d'hémoglobine A1c et plusieurs complications postopératoires ont été démontrés, certes de façon quelque peu erratique, dans diverses interventions chirurgicales. 10,12 Bien qu'il existe des lacunes encore plus importantes dans la littérature entre association et causation que pour l'ISO et l'hyperglycémie postopératoire, le coût relativement peu élevé du traitement du diabète et son acceptation généralisée parmi les patients jouent en faveur d'un dépistage préopératoire de taux anormaux de l'hémoglobine A1c. Malheureusement, le peu de comptes rendus examinant les programmes d'intervention visant à identifier et traiter des taux élevés d'hémoglobine A1c sont de nature observationnelle.…”

“…The relation between elevated hemoglobin A1c and a number of postoperative complications has been demonstrated, albeit somewhat inconsistently, for a variety of surgical procedures. 10,12 Although there is an even larger gap in the literature between association and causation here than exists for SSI and postoperative hyperglycemia, the relatively low cost of diabetes treatment and its general acceptance by patients enhance the appeal of preoperative screening for abnormal HbA1c. Unfortunately, reports of intervention programs designed to identify and treat elevated hemoglobin A1c are scarce, observational in design, and either underpowered to detect meaningful differences in complication rates 13 or only measure surrogate outcomes, such as improved glucose levels on the day of surgery.…”