Department of General Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
Department of Surgery,Mayo Clinic, Jacksonville, Florida.
Surg Obes Relat Dis. 2021 Apr;17(4):744-755. doi: 10.1016/j.soard.2020.11.022. Epub 2020 Nov 28.
More than 90% of patients with type 2 diabetes (T2D) have obesity, and over 85% of diabetic patients who undergo metabolic and bariatric surgery (MBS) will see improvement or resolution of diabetes. However, diabetes is a known risk factor for surgical complications.
To determine whether poor preoperative glycemic control confers an increased perioperative risk after MBS.
Academic Hospital.
Retrospective review of data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). From the 2017-2018 MBSAQIP databases, we identified patients with diabetes who underwent Roux-en-Y gastric bypass or gastric sleeve surgery. Unmatched and propensity-matched univariate analyses, as well as multivariate logistic regressions, were performed to compare 30-day postoperative outcomes and complication rates between patients with poor (glycated hemoglobin [HbA1C] > 7.0) and good (HbA1C ≤ 7.0) glycemic control.
Of 40,132 T2D patients, 19,094 (52.42%) had an HbA1C level ≤ 7.0. Patients with poor glycemic control had slightly higher rates of overall morbidity (6.53% versus 5.49%, respectively; relative risk = 1.188; P < .001). However, in a 1:1 matched analysis of 23,930 patients controlling for body mass index, surgery type, approach, and co-morbidities, the findings of poorer outcomes were largely mitigated. In a multivariate analysis, poor glycemic control was not associated with morbidity.
In T2D patients, poor glycemic control does not independently increase the risk of 30-day morbidity following MBS. Adverse outcomes in the setting of poor glycemic control appear to be largely mediated by associated co-morbidities. Performing MBS in the setting of suboptimal glycemic control may be justified, with the understanding that delaying or refusing surgery can contribute to worsening of diabetes-related co-morbidities that, in turn, may ultimately have a more deleterious effect on outcomes.
超过 90%的 2 型糖尿病（T2D）患者存在肥胖，超过 85%接受代谢和减重手术（MBS）的糖尿病患者的糖尿病将得到改善或缓解。然而，糖尿病是手术并发症的已知危险因素。
确定术前血糖控制不佳是否会增加 MBS 后的围手术期风险。
学术医院。
回顾性分析代谢和减重手术认证和质量改进计划（MBSAQIP）的数据。从 2017-2018 年 MBSAQIP 数据库中，我们确定了接受 Roux-en-Y 胃旁路术或胃袖状切除术的糖尿病患者。进行了未匹配和倾向匹配的单变量分析，以及多变量逻辑回归分析，以比较血糖控制不佳（糖化血红蛋白[HbA1C]＞7.0）和良好（HbA1C≤7.0）的患者 30 天术后结局和并发症发生率。
在 40132 名 T2D 患者中，有 19094 名（52.42%）HbA1C 水平≤7.0。血糖控制不佳的患者总发病率略高（分别为 6.53%和 5.49%；相对风险=1.188；P＜0.001）。然而，在对 23930 名患者进行了 1：1 匹配分析，控制了体重指数、手术类型、入路和合并症后，发现不良结果在很大程度上得到了缓解。在多变量分析中，血糖控制不佳与发病率无关。
在 T2D 患者中，血糖控制不佳不会独立增加 MBS 后 30 天发病率的风险。血糖控制不佳情况下的不良结局似乎在很大程度上由相关合并症介导。在血糖控制不佳的情况下进行 MBS 可能是合理的，应理解的是，延迟或拒绝手术可能会导致糖尿病相关合并症恶化，而这些合并症反过来又可能对结局产生更有害的影响。
