School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia.
Department of Pharmacy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Diabet Med. 2024 Oct;41(10):e15380. doi: 10.1111/dme.15380. Epub 2024 Jun 10.
Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A (HbA) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA levels on postoperative outcomes in adults who had undergone major noncardiac surgery.
We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case-control studies) which measured HbA within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946).
Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA was associated with increased odds of these complications. No association with reoperations and 30-day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism.
Current evidence suggested that higher preoperative HbA levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. Further high-quality studies would be needed to quantify the risks posed and determine whether early intervention improves outcomes.
已知糖尿病会增加重大手术后的发病率和死亡率。然而，关于术前升高的血红蛋白 A（HbA）水平是否与重大非心脏手术后的不良结局相关，文献存在争议。我们旨在研究成年人接受重大非心脏手术后，术前 HbA 水平的递增与术后结局的关系。
我们系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库，以获取 2012 年 1 月至 2023 年 7 月发表的符合条件的研究。纳入了测量术前 6 个月内 HbA 水平并比较至少三个递增亚组或分析 HbA 为连续变量的随机对照试验和观察性研究（队列和病例对照研究）。系统评价方案已在 PROSPERO（CRD42023391946）中注册。
共纳入了 20 项研究，涉及多种手术类型的结局。较高的术前 HbA 水平与术后总体并发症、术后急性肾损伤、吻合口漏、手术部位感染和住院时间延长的几率增加相关。术前 HbA 每增加 1%，这些并发症的几率就会增加。与再次手术和 30 天死亡率无关联。文献在复合主要并发症、围手术期心血管事件、医院再入院、术后肺炎和全身血栓栓塞方面差异很大。
目前的证据表明，成年人接受重大非心脏手术后，术前 HbA 水平较高与术后并发症几率增加和住院时间延长相关。需要进一步开展高质量的研究，以量化风险，并确定早期干预是否能改善结局。
