2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Training and Innovation in Surgery (CERTAIN Surgery), Centre for Research, Krakow, Poland.
Obes Surg. 2019 Sep;29(9):2957-2962. doi: 10.1007/s11695-019-03936-y.
Available clinical data on the influence of baseline HbA postoperative morbidity and readmission after laparoscopic sleeve gastrectomy is scarce. This prompted us to conduct a multicenter retrospective study evaluating the influence of chronic hyperglycemia on postoperative course among patients undergoing laparoscopic sleeve gastrectomy (SG). We aimed to investigate the influence of baseline HbA levels on postoperative outcomes in patients after SG.
We conducted a multicenter retrospective cohort study of consecutive patients who underwent SG from March 2017 to March 2018 in seven referral centers for bariatric surgery. Exclusion criteria were revision surgeries, different bariatric interventions, SG combined with other procedures, and lack of necessary data. Patients were divided into three groups depending on their preoperative glycated hemoglobin level (HbA) < 5.7%, 5.7-6.4%, and ≥ 6.5%. Primary endpoints were influence of HbA on early and late postoperative morbidity, impact on prolonged length of hospital stay (LOS), and readmission rate.
The HbA < 5.7% group comprised 842 (49%) patients, HbA 5.7-6.4% comprised 587 (34%), and HbA ≥ 6.5% comprised 289 (17%). Overall morbidity was 6.23%; this did not differ among groups (p = 0.571). Three patients died postoperatively. Late postoperative morbidity was comparable among groups (p = 0.312). The ratio of prolonged LOS and readmission did not differ among groups (p = 0.363 and 0.571). ROC analysis revealed that HbA > 7.3% increased OR for hospital readmission (p = 0.007).
Preoperative HbA does not affect postoperative morbidity and prolonged LOS after SG. Patients with HbA > 7.3% have an increased chance of hospital readmission.
腹腔镜袖状胃切除术（LSG）后，HbA1c 基线水平对术后发病率和再入院率的影响的临床数据有限。这促使我们进行了一项多中心回顾性研究，评估慢性高血糖对 LSG 患者术后过程的影响。我们旨在研究 LSG 后患者的 HbA1c 基线水平对术后结果的影响。
我们对 2017 年 3 月至 2018 年 3 月期间在 7 家减重手术转诊中心接受 LSG 的连续患者进行了多中心回顾性队列研究。排除标准为修正手术、不同的减重干预措施、LSG 与其他手术联合进行以及缺乏必要数据。根据术前糖化血红蛋白（HbA1c）水平将患者分为三组：<5.7%、5.7-6.4%和≥6.5%。主要终点是 HbA1c 对早期和晚期术后发病率的影响，对延长住院时间（LOS）和再入院率的影响。
HbA1c<5.7%组有 842 例（49%）患者，HbA1c 5.7-6.4%组有 587 例（34%），HbA1c≥6.5%组有 289 例（17%）。总体发病率为 6.23%；组间无差异（p=0.571）。术后有 3 例死亡。组间晚期术后发病率相似（p=0.312）。延长 LOS 和再入院的比例在组间无差异（p=0.363 和 0.571）。ROC 分析显示，HbA1c>7.3%增加了医院再入院的 OR（p=0.007）。
术前 HbA1c 水平不会影响 LSG 后的术后发病率和延长 LOS。HbA1c>7.3%的患者有更高的住院再入院机会。
