Haemoglobin A1c as a predictor of postoperative hyperglycaemia and complications after major colorectal surgery.
BACKGROUND
Hyperglycaemia following major surgery increases morbidity, but may be improved by use of enhanced-recovery protocols. It is not known whether preoperative haemoglobin (Hb) A1c could predict hyperglycaemia and/or adverse outcome after colorectal surgery.


METHODS
Some 120 patients without known diabetes underwent major colorectal surgery within an enhanced-recovery protocol. HbA1c was measured at admission and 4 weeks after surgery. All patients received an oral diet beginning 4 h after operation. Plasma glucose was monitored five times daily. Patients were stratified according to preoperative levels of HbA1c (within normal range of 4.5-6.0 per cent, or higher).


RESULTS
Thirty-one patients (25.8 per cent) had a preoperative HbA1c level over 6.0 per cent. These had higher mean(s.d.) postoperative glucose (9.3(1.5) versus 8.0(1.5) mmol/l; P < 0.001) and C-reactive protein (137(65) versus 101(52) mg/l; P = 0.008) levels than patients with a normal HbA1c level. Postoperative complications were more common in patients with a high HbA1c level (odds ratio 2.9 (95 per cent confidence interval 1.1 to 7.9)).


CONCLUSIONS
Postoperative hyperglycaemia is common among patients with no history of diabetes, even within an enhanced-recovery protocol. Preoperative measurement of HbA1c may identify patients at higher risk of poor glycaemic control and postoperative complications.
Centre for Gastrointestinal Disease, Ersta Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden. ulf.gustafsson@erstadiakoni.se
U O
UO
Gustafsson
A
A
Thorell
M
M
Soop
O
O
Ljungqvist
J
J
Nygren
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011300:Preoperative Care; D012002:Rectal Diseases / Q000601:surgery*
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin