title: Effects of preoperative long-term glycemic control on operative outcomes following pancreaticoduodenectomy.
abstract: BACKGROUND
  Diabetes mellitus is postulated to be both a risk factor and manifestation of pancreatic adenocarcinoma. This study evaluated the effects of preoperative glycemic control as determined by hemoglobin A1c (HbA1c) on outcomes following pancreaticoduodenectomy (PD).
  
  
  METHODS
  A prospective cohort study whereby HbA1c was assessed preoperatively in 243 patients undergoing PD was performed. The primary outcome measure was operative morbidity. Secondary outcomes included individual adverse events, time to dietary resumption, and length of stay.
  
  
  RESULTS
  Preoperative HbA1c ranged from 4.0% to 13.5%. Overall morbidity and incidence of specific adverse events were similar regardless of preoperative HbA1c. No correlation between HbA1c and length of stay, dietary resumption, or readmission was observed. Pancreatic fistula formation had a decreased incidence in patients with elevated versus normal HbA1c (2.2% vs. 9.6%, P = .083).
  
  
  CONCLUSIONS
  PD can be safely performed in patients with HbA1c levels suggestive of poor long-term preoperative glycemic control. Medical efforts to optimize HbA1c should not delay resection.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Kunstman
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Healy
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Araya
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: ronald.salem@yale.edu.
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Salem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; Hemoglobin A1c; Pancreatic adenocarcinoma; Pancreaticoduodenectomy; Surgical outcomes