title: Is glycosylated hemoglobin A1 c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass?
abstract: BACKGROUND
  Glycosylated hemoglobin A1 c (HbA1 c) has been described as a risk factor for adverse outcome after cardiovascular and colorectal surgery, but not for obese patients undergoing bariatric surgery. The objective of this study was to see if there is an association between HbA1 c and adverse outcome in laparoscopic gastric bypass surgery.
  
  
  METHODS
  From the Scandinavian Obesity Surgery Registry we identified 12,850 patients, without treatment for diabetes and operated with laparoscopic gastric bypass between January 1, 2010 and September 30, 2012, and where a baseline HbA1 c value was registered. Preoperative data were compared with data from a 30-day follow-up. Severe complications were defined according to the Clavien-Dindo-Scale as Grade 3 b or higher.
  
  
  RESULTS
  HbA1 c levels below 5.7 % were associated with a lower incidence of severe complications (2.7 %) than higher levels (HbA1 c 5.7-6.49% incidence 3.5%, P = .015; HbA1 c>6.5%, incidence 4.5%, P = .012). After multivariate analysis with patient-specific confounders the difference remained significant (HbA1 c 5.7-6.49% adjusted P = .046; HbA1 c>6.5% adjusted P = .023) CONCLUSION: Elevated HbA1 c levels in patients without pharmacologic treatment for diabetes undergoing laparoscopic gastric bypass surgery is associated with an increased risk for severe complications during the first 30 postoperative days. This is the case, even at levels not regarded as diagnostic for diabetes.
authors.affiliation: Department of Surgery, Örebro University Hospital, Örebro, Sweden; Department of Surgery, Lindesberg Hospital, Lindesberg, Sweden. Electronic address: erik.stenberg@orebroll.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Stenberg
authors.affiliation: Department of Surgery, Örebro University Hospital, Örebro, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Szabo
authors.affiliation: Department of Surgery, Örebro University Hospital, Örebro, Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Näslund
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009765:Obesity / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin
keywords: Glycosylated; Hemoglobin A1 c; Laparoscopic gastric bypass; Nondiabetic; Postoperative complications; Risk factor