Hamid Safraz A, Graetz Elena, Zolfaghari Emily J, Schultz Kurt S, Schneider Eric B, Gibbs Karen E
Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA.
Yale National Clinician Scholars Program, New Haven, CT, 06510, USA.
Perioper Med (Lond). 2025 Jan 10;14(1):3. doi: 10.1186/s13741-024-00483-8.
Irrespective of baseline diabetes status, preoperative hemoglobin A1c (A1C) influences perioperative care in patients undergoing metabolic and bariatric surgery (MBS). Accordingly, the American Society of Metabolic and Bariatric Surgery (ASMBS) endorses that patients undergoing MBS should receive a preoperative A1C test. We aimed to assess the proportion of MBS patients who received a preoperative A1C test and determine whether baseline diabetes status influences receipt of a test.
We queried the 2017 to 2022 MBSAQIP database for patients undergoing open, laparoscopic, or robotic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy. Using descriptive methods, we compared the clinical and demographic characteristics of patients who received a preoperative A1C test with patients who did not. We performed logistic regression analysis using diabetes status as a predictor variable and receipt of a test as the outcome, covarying for sociodemographic and clinical factors.
We identified 996,217 patients who underwent RYGB or sleeve gastrectomy between 2017 to 2022. The average age of the cohort was 43.8 years (SD = 11.9) and 81.0% were female. Overall, 45.7% received a preoperative A1C test. The proportion who was tested increased over the six-year study period, from 35.5% in 2017 to 56.0% in 2022. Compared to those who were not tested, patients who were tested were more likely to have several cardiopulmonary comorbidities, including COPD (1.4% vs 1.2%, p < 0.001), PE (1.4% vs 1.2%, p < 0.001), sleep apnea (39.3 vs. 36.4%, p < 0.001), HTN (47.1% vs 44.0%, p < 0.001), and MI (1.2% vs. 1.0%, p < 0.001), though the differences in proportions were small and may not be clinically significant. Compared to patients who did not have diabetes or had diabetes controlled by diet alone, patients with non-insulin dependent diabetes had 77% increased odds of receiving a A1C test (adjusted OR (aOR) 1.77, p < 0.001); insulin dependent patients had 113% increased odds (aOR 2.13, p < 0.001).
Despite society recommendations endorsing measurement of preoperative A1C prior to MBS, less than half of patients undergoing MBS between 2017 and 2022 received a preoperative A1C test. Additionally, there were differential patterns in testing based on diabetes status. Preoperative glycemic evaluation is an area for continued quality improvement.
无论基线糖尿病状态如何，术前糖化血红蛋白（A1C）都会影响接受代谢和减重手术（MBS）患者的围手术期护理。因此，美国代谢和减重外科学会（ASMBS）支持接受MBS的患者应接受术前A1C检测。我们旨在评估接受术前A1C检测的MBS患者比例，并确定基线糖尿病状态是否会影响检测的接受情况。
我们查询了2017年至2022年MBSAQIP数据库中接受开放、腹腔镜或机器人Roux-en-Y胃旁路术（RYGB）或袖状胃切除术的患者。使用描述性方法，我们比较了接受术前A1C检测的患者与未接受检测的患者的临床和人口统计学特征。我们以糖尿病状态作为预测变量，检测接受情况作为结果进行逻辑回归分析，并对社会人口统计学和临床因素进行协变量分析。
我们确定了2017年至2022年间接受RYGB或袖状胃切除术的996217例患者。该队列的平均年龄为43.8岁（标准差=11.9），81.0%为女性。总体而言，45.7%的患者接受了术前A1C检测。在六年的研究期间，接受检测的比例有所增加，从2017年的35.5%增至2022年的56.0%。与未接受检测的患者相比，接受检测的患者更有可能患有几种心肺合并症，包括慢性阻塞性肺疾病（COPD）（1.4%对1.2%，p<0.001）、肺栓塞（PE）（1.4%对1.2%，p<0.001）、睡眠呼吸暂停（39.3%对36.4%，p<0.001）、高血压（HTN）（47.1%对44.0%，p<0.001）和心肌梗死（MI）（1.2%对1.0%，p<0.001），尽管比例差异较小，可能无临床意义。与没有糖尿病或仅通过饮食控制糖尿病的患者相比，非胰岛素依赖型糖尿病患者接受A1C检测的几率增加了77%（调整后的比值比（aOR）为1.77，p<0.001）；胰岛素依赖型患者的几率增加了113%（aOR为2.13，p<0.001）。
尽管学会建议在MBS术前进行A1C检测，但在2017年至2022年间接受MBS的患者中，不到一半接受了术前A1C检测。此外，基于糖尿病状态的检测模式存在差异。术前血糖评估是持续质量改进的一个领域。
