Hyperglycemia common, linked with poor outcomes in general surgery patients
More than 6% of 282,131 general surgery patients had HbA1c levels in the diabetic range but did not have a diabetes diagnosis, an analysis of a U.S. database found.
Hyperglycemia was highly prevalent among general surgery patients and is independently associated with increased risks of complications, according to a recent cohort study.
To better understand if elevated HbA1c levels were associated with increased 30-day postoperative adverse events among patients undergoing general surgeries, researchers used the American College of Surgeons National Surgical Quality Improvement Program database to identify 282,131 patients (mean age, 60 years) who had a surgery in 2021 to 2023 and had a documented HbA1c level. Patients without a diabetes diagnosis but with an HbA1c level higher than 6.4% were considered to have undiagnosed diabetes. Patients without a diabetes diagnosis and with an HbA1c level less than 5.7% served as the control group. Findings were published by JAMA Surgery on Nov. 5.
Of the included patients, 36% (n=101,160) had diagnosed diabetes and 6.4% (n=18,133) had undiagnosed diabetes. In patients with diabetes, risk of any complication compared to controls increased progressively with HbA1c level (odds ratios [ORs], 1.06 [95% CI, 1.00 to 1.11] with an HbA1c level <6.0% and 1.32 [95% CI, 1.25 to 1.39] with an HbA1c level >9.0%). Undiagnosed diabetes was associated with higher risks of medical complications (OR, 1.11; 95% CI, 1.04 to 1.18) and mortality (OR, 1.24; 95% CI, 1.07 to 1.42) than no diabetes.
Subgroup analyses showed that the association between hyperglycemia and medical complications was strongest in patients undergoing abdominal operations such as laparoscopic cholecystectomy without visualization of the bile ducts, laparoscopic appendectomy, and laparoscopic sleeve gastrectomy, among others.
Limitations include that the database relied on information from academic centers and findings may not be generalizable to smaller institutions, the researchers cautioned. The analysis did not include data on diabetes type, treatment regimen, and perioperative interventions.
Overall, “these findings support routine preoperative HbA1c screening and the adoption of individualized glycemic management strategies to optimize surgical risk assessment, reduce complications, and improve perioperative outcomes,” the authors concluded.