Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery

Christopher J. Goodenough; Mike K. Liang; Mylan T. Nguyen; Duyen H. Nguyen; Julie L. Holihan; Zeinab M. Alawadi; John S. Roth; Curtis J. Wray; Tien C. Ko; Lillian S. Kao

doi:10.1016/j.jamcollsurg.2015.07.013

Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery

Christopher J. Goodenough
, Mike K. Liang
, Mylan T. Nguyen
, Duyen H. Nguyen
, Julie L. Holihan
, Zeinab M. Alawadi
, John S. Roth
, Curtis J. Wray
, Tien C. Ko
, Lillian S. Kao

Surgery

Research output: Contribution to journal › Article › peer-review

92 Scopus citations

Abstract

Background Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. Study Design A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Results Among 438 patients who had a measured HbA1c, 96 (21.9%) experienced a major complication. On multivariate analysis, HbA1c ≥6.5% (odds ratio = 1.95; 95% CI, 1.17-3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p < 0.01). Predicted probabilities demonstrated that both HbA1c and glucose together contributed to major complications; and HbA1c impacted the ability to achieve optimal perioperative glucose control. Patients with a BMI >30 kg/m², history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥6.5%. Conclusions Elevated HbA1c ≥6.5% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes.

Original language	English
Pages (from-to)	854-861.e1
Journal	Journal of the American College of Surgeons
Volume	221
Issue number	4
DOIs	https://doi.org/10.1016/j.jamcollsurg.2015.07.013
State	Published - Oct 1 2015

Bibliographical note

Publisher Copyright:
© 2015 American College of Surgeons.

Funding

Support: This work was supported by the Center for Clinical and Translational Sciences, which is funded by National Institutes of Health Clinical and Translational Award UL1 TR000371 and KL2 TR000370 from the National Center for Advancing Translational Sciences.

Funders	Funder number
National Institutes of Health (NIH)	UL1 TR000371
National Institutes of Health (NIH)
National Center for Advancing Translational Sciences (NCATS)	KL2TR000370
National Center for Advancing Translational Sciences (NCATS)
Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston

ASJC Scopus subject areas

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jamcollsurg.2015.07.013

Cite this

Goodenough, C. J., Liang, M. K., Nguyen, M. T., Nguyen, D. H., Holihan, J. L., Alawadi, Z. M., Roth, J. S., Wray, C. J., Ko, T. C., & Kao, L. S. (2015). Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery. Journal of the American College of Surgeons, 221(4), 854-861.e1. https://doi.org/10.1016/j.jamcollsurg.2015.07.013

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title = "Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery",

abstract = "Background Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. Study Design A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Results Among 438 patients who had a measured HbA1c, 96 (21.9\%) experienced a major complication. On multivariate analysis, HbA1c ≥6.5\% (odds ratio = 1.95; 95\% CI, 1.17-3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p < 0.01). Predicted probabilities demonstrated that both HbA1c and glucose together contributed to major complications; and HbA1c impacted the ability to achieve optimal perioperative glucose control. Patients with a BMI >30 kg/m2, history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥6.5\%. Conclusions Elevated HbA1c ≥6.5\% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes.",

author = "Goodenough, \{Christopher J.\} and Liang, \{Mike K.\} and Nguyen, \{Mylan T.\} and Nguyen, \{Duyen H.\} and Holihan, \{Julie L.\} and Alawadi, \{Zeinab M.\} and Roth, \{John S.\} and Wray, \{Curtis J.\} and Ko, \{Tien C.\} and Kao, \{Lillian S.\}",

note = "Publisher Copyright: {\textcopyright} 2015 American College of Surgeons.",

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Goodenough, CJ, Liang, MK, Nguyen, MT, Nguyen, DH, Holihan, JL, Alawadi, ZM, Roth, JS, Wray, CJ, Ko, TC & Kao, LS 2015, 'Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery', Journal of the American College of Surgeons, vol. 221, no. 4, pp. 854-861.e1. https://doi.org/10.1016/j.jamcollsurg.2015.07.013

TY - JOUR

T1 - Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery

AU - Goodenough, Christopher J.

AU - Liang, Mike K.

AU - Nguyen, Mylan T.

AU - Nguyen, Duyen H.

AU - Holihan, Julie L.

AU - Alawadi, Zeinab M.

AU - Roth, John S.

AU - Wray, Curtis J.

AU - Ko, Tien C.

AU - Kao, Lillian S.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. Study Design A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Results Among 438 patients who had a measured HbA1c, 96 (21.9%) experienced a major complication. On multivariate analysis, HbA1c ≥6.5% (odds ratio = 1.95; 95% CI, 1.17-3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p < 0.01). Predicted probabilities demonstrated that both HbA1c and glucose together contributed to major complications; and HbA1c impacted the ability to achieve optimal perioperative glucose control. Patients with a BMI >30 kg/m2, history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥6.5%. Conclusions Elevated HbA1c ≥6.5% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes.

AB - Background Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. Study Design A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Results Among 438 patients who had a measured HbA1c, 96 (21.9%) experienced a major complication. On multivariate analysis, HbA1c ≥6.5% (odds ratio = 1.95; 95% CI, 1.17-3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p < 0.01). Predicted probabilities demonstrated that both HbA1c and glucose together contributed to major complications; and HbA1c impacted the ability to achieve optimal perioperative glucose control. Patients with a BMI >30 kg/m2, history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥6.5%. Conclusions Elevated HbA1c ≥6.5% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes.

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ER -

Preoperative glycosylated hemoglobin and postoperative glucose together predict major complications after abdominal surgery

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

UN SDGs

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