Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery

What is the role of Plasma Hemoglobin A1c?

Faisal Jehan, Muhammad Khan, Joseph V. Sakran, Mohammad Khreiss, Terence OKeeffe, Albert Chi, Narong Kulvatunyou, Arpana Jain, El Rasheid Zakaria, Bellal Joseph

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included. Patients were divided into two groups (HbA1c < 6 and HbA1c ≥ 6). Our primary outcome measures included in-hospital complications (major and minor complications), hospital and intensive care unit length of stay, and mortality. Secondary outcomes measures were 30-day complications, readmissions, and mortality. Multivariate and linear regressions were performed. RESULTS Of the 402 study patients, mean age was 61 ± 12 years, 53% were females, and 63.8% were diabetics. Overall, 49% had an HbA1c ≥ 6%; the mortality rate was 6%. Those with hypertension, history of coronary artery disease, and body mass index of 30 kg/m2 or greater were more likely to have HbA1c of 6.0% or greater. 7.9% patients experienced major complications. Patients with HbA1c of 6% or greater had a higher complication rate (36% vs 11%, p < 0.001) than those with HbA1c less than 6%. However there was no difference in mortality between two groups (p = 0.09). After controlling for confounders, HbA1c ≥ 6.0% (odds ratio [OR], 2.9; p < 0.01) and a postoperative random blood sugar (RBS) of 200 mg/dL or greater (OR, 2.3; p < 0.01) were independent predictors of major complications. Patients with both HbA1c of 6.0% or greater and postoperative RBS of 200 or greater had higher odds (OR, 4.2; p < 0.01) of developing major complication. After adjusting for confounders, a higher HbA1c was independently correlated with a higher postoperative RBS (b = 0.494, [19.7-28.4], p = 0.02), but there was no correlation with the preoperative RBS. CONCLUSION Patients with HbA1c of 6.0% or greater and a postoperative RBS of 200 mg/dL or greater have a four times higher risk of developing major complications after EGS. A preoperative HbA1c can stratify patients prone to develop postoperative hyperglycemia, regardless of their preoperative RBS. LEVEL OF EVIDENCE Prognostic, level III.

Original languageEnglish (US)
Pages (from-to)112-117
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume84
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Hemoglobins
Emergencies
Blood Glucose
Mortality
Odds Ratio
Outcome Assessment (Health Care)
Hyperglycemia
Quality Control
Intensive Care Units
Coronary Artery Disease
Linear Models
Length of Stay
Body Mass Index
Databases
Hypertension
Morbidity
Glucose

Keywords

  • Glycosylated hemoglobin
  • perioperative glucose control
  • postoperative complications

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery : What is the role of Plasma Hemoglobin A1c? / Jehan, Faisal; Khan, Muhammad; Sakran, Joseph V.; Khreiss, Mohammad; OKeeffe, Terence; Chi, Albert; Kulvatunyou, Narong; Jain, Arpana; Zakaria, El Rasheid; Joseph, Bellal.

In: Journal of Trauma and Acute Care Surgery, Vol. 84, No. 1, 01.01.2018, p. 112-117.

Research output: Contribution to journalArticle

Jehan, Faisal ; Khan, Muhammad ; Sakran, Joseph V. ; Khreiss, Mohammad ; OKeeffe, Terence ; Chi, Albert ; Kulvatunyou, Narong ; Jain, Arpana ; Zakaria, El Rasheid ; Joseph, Bellal. / Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery : What is the role of Plasma Hemoglobin A1c?. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 84, No. 1. pp. 112-117.
@article{b19363a574d046c084b2adfcc0aac5e8,
title = "Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery: What is the role of Plasma Hemoglobin A1c?",
abstract = "BACKGROUND Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included. Patients were divided into two groups (HbA1c < 6 and HbA1c ≥ 6). Our primary outcome measures included in-hospital complications (major and minor complications), hospital and intensive care unit length of stay, and mortality. Secondary outcomes measures were 30-day complications, readmissions, and mortality. Multivariate and linear regressions were performed. RESULTS Of the 402 study patients, mean age was 61 ± 12 years, 53{\%} were females, and 63.8{\%} were diabetics. Overall, 49{\%} had an HbA1c ≥ 6{\%}; the mortality rate was 6{\%}. Those with hypertension, history of coronary artery disease, and body mass index of 30 kg/m2 or greater were more likely to have HbA1c of 6.0{\%} or greater. 7.9{\%} patients experienced major complications. Patients with HbA1c of 6{\%} or greater had a higher complication rate (36{\%} vs 11{\%}, p < 0.001) than those with HbA1c less than 6{\%}. However there was no difference in mortality between two groups (p = 0.09). After controlling for confounders, HbA1c ≥ 6.0{\%} (odds ratio [OR], 2.9; p < 0.01) and a postoperative random blood sugar (RBS) of 200 mg/dL or greater (OR, 2.3; p < 0.01) were independent predictors of major complications. Patients with both HbA1c of 6.0{\%} or greater and postoperative RBS of 200 or greater had higher odds (OR, 4.2; p < 0.01) of developing major complication. After adjusting for confounders, a higher HbA1c was independently correlated with a higher postoperative RBS (b = 0.494, [19.7-28.4], p = 0.02), but there was no correlation with the preoperative RBS. CONCLUSION Patients with HbA1c of 6.0{\%} or greater and a postoperative RBS of 200 mg/dL or greater have a four times higher risk of developing major complications after EGS. A preoperative HbA1c can stratify patients prone to develop postoperative hyperglycemia, regardless of their preoperative RBS. LEVEL OF EVIDENCE Prognostic, level III.",
keywords = "Glycosylated hemoglobin, perioperative glucose control, postoperative complications",
author = "Faisal Jehan and Muhammad Khan and Sakran, {Joseph V.} and Mohammad Khreiss and Terence OKeeffe and Albert Chi and Narong Kulvatunyou and Arpana Jain and Zakaria, {El Rasheid} and Bellal Joseph",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/TA.0000000000001724",
language = "English (US)",
volume = "84",
pages = "112--117",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery

T2 - What is the role of Plasma Hemoglobin A1c?

AU - Jehan, Faisal

AU - Khan, Muhammad

AU - Sakran, Joseph V.

AU - Khreiss, Mohammad

AU - OKeeffe, Terence

AU - Chi, Albert

AU - Kulvatunyou, Narong

AU - Jain, Arpana

AU - Zakaria, El Rasheid

AU - Joseph, Bellal

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included. Patients were divided into two groups (HbA1c < 6 and HbA1c ≥ 6). Our primary outcome measures included in-hospital complications (major and minor complications), hospital and intensive care unit length of stay, and mortality. Secondary outcomes measures were 30-day complications, readmissions, and mortality. Multivariate and linear regressions were performed. RESULTS Of the 402 study patients, mean age was 61 ± 12 years, 53% were females, and 63.8% were diabetics. Overall, 49% had an HbA1c ≥ 6%; the mortality rate was 6%. Those with hypertension, history of coronary artery disease, and body mass index of 30 kg/m2 or greater were more likely to have HbA1c of 6.0% or greater. 7.9% patients experienced major complications. Patients with HbA1c of 6% or greater had a higher complication rate (36% vs 11%, p < 0.001) than those with HbA1c less than 6%. However there was no difference in mortality between two groups (p = 0.09). After controlling for confounders, HbA1c ≥ 6.0% (odds ratio [OR], 2.9; p < 0.01) and a postoperative random blood sugar (RBS) of 200 mg/dL or greater (OR, 2.3; p < 0.01) were independent predictors of major complications. Patients with both HbA1c of 6.0% or greater and postoperative RBS of 200 or greater had higher odds (OR, 4.2; p < 0.01) of developing major complication. After adjusting for confounders, a higher HbA1c was independently correlated with a higher postoperative RBS (b = 0.494, [19.7-28.4], p = 0.02), but there was no correlation with the preoperative RBS. CONCLUSION Patients with HbA1c of 6.0% or greater and a postoperative RBS of 200 mg/dL or greater have a four times higher risk of developing major complications after EGS. A preoperative HbA1c can stratify patients prone to develop postoperative hyperglycemia, regardless of their preoperative RBS. LEVEL OF EVIDENCE Prognostic, level III.

AB - BACKGROUND Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS). METHODS We performed a 3-year analysis of our prospectively maintained EGS database. Patients who had HbA1c levels measured within 3 months before surgery were included. Patients were divided into two groups (HbA1c < 6 and HbA1c ≥ 6). Our primary outcome measures included in-hospital complications (major and minor complications), hospital and intensive care unit length of stay, and mortality. Secondary outcomes measures were 30-day complications, readmissions, and mortality. Multivariate and linear regressions were performed. RESULTS Of the 402 study patients, mean age was 61 ± 12 years, 53% were females, and 63.8% were diabetics. Overall, 49% had an HbA1c ≥ 6%; the mortality rate was 6%. Those with hypertension, history of coronary artery disease, and body mass index of 30 kg/m2 or greater were more likely to have HbA1c of 6.0% or greater. 7.9% patients experienced major complications. Patients with HbA1c of 6% or greater had a higher complication rate (36% vs 11%, p < 0.001) than those with HbA1c less than 6%. However there was no difference in mortality between two groups (p = 0.09). After controlling for confounders, HbA1c ≥ 6.0% (odds ratio [OR], 2.9; p < 0.01) and a postoperative random blood sugar (RBS) of 200 mg/dL or greater (OR, 2.3; p < 0.01) were independent predictors of major complications. Patients with both HbA1c of 6.0% or greater and postoperative RBS of 200 or greater had higher odds (OR, 4.2; p < 0.01) of developing major complication. After adjusting for confounders, a higher HbA1c was independently correlated with a higher postoperative RBS (b = 0.494, [19.7-28.4], p = 0.02), but there was no correlation with the preoperative RBS. CONCLUSION Patients with HbA1c of 6.0% or greater and a postoperative RBS of 200 mg/dL or greater have a four times higher risk of developing major complications after EGS. A preoperative HbA1c can stratify patients prone to develop postoperative hyperglycemia, regardless of their preoperative RBS. LEVEL OF EVIDENCE Prognostic, level III.

KW - Glycosylated hemoglobin

KW - perioperative glucose control

KW - postoperative complications

UR - http://www.scopus.com/inward/record.url?scp=85040012397&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040012397&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001724

DO - 10.1097/TA.0000000000001724

M3 - Article

VL - 84

SP - 112

EP - 117

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -