Association of Preoperative Glycosylated Hemoglobin Level with 30-Day Outcomes Following Laparoscopic Roux-en-Y Gastric Bypass: an Analysis of the ACS-MBSAQIP Database.

PURPOSE

Elevated glycosylated hemoglobin (HbAc) levels have been associated with increased morbidity and mortality following several cardiac, colorectal, orthopedic, and vascular surgery operations. The purpose of this study was to determine if there is a HgAc cut-point that can be used in patients undergoing laparoscopic Roux-en-Y gastric bypass to decrease the risk of 30-day wound events and additional 30-day morbidity and mortality.

MATERIALS AND METHODS

All patients undergoing first-time, elective Roux-en-Y gastric bypass in 2017 and 2018 with a diagnosis of diabetes mellitus (DM) and a preoperative HbAc level were identified within the American College of Surgeons Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (ACS-MBSAQIP) database. The association of preoperative HbAc levels with 30-day morbidity and mortality was investigated.

RESULTS

A total of 13,806 patients met inclusion criteria. Two natural HbAc inflection points for composite wound events, including superficial, deep, and organ space surgical site infections (SSI) and wound dehiscence, were found. A HbAc level of ≤ 6.5% was associated with a decreased odds of experiencing the composite 30-day wound event outcome while a HbAc level of > 8.6% was associated with an increased odds of experiencing the composite 30-day wound event outcome. The differences in the incidence of the 30-day composite wound event outcomes were driven primarily by superficial and organ space SSI, including anastomotic leaks.

CONCLUSION

Patients with DM being evaluated for RYGB surgery with a HbAc level > 8.6% are at an increased risk for 30-day wound events, including superficial and organ space SSI.