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.
Gustafsson
U O
UO
Centre for Gastrointestinal Disease, Ersta Hospital, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden. ulf.gustafsson@erstadiakoni.se
Thorell
A
A
Soop
M
M
Ljungqvist
O
O
Nygren
J
J
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