title: Preoperative HBA1c and risk of postoperative complications in patients with gynaecological cancer.
abstract: HBA1c is used as an indicator for the long-term control of the glycaemic state and outcome predictors in diabetic patients. Diabetic patients have an increased risk of post-operative complications especially those related to infection. The aim of our study is to ascertain the relationship between HBA1c levels and post-operative recovery within the subspecialty of gynaecological oncology.
  
  
  
  Prospective cohort study during the period 1 August 2012 through 31 August 2014. Preoperative measurement of HBA1c on all gynaecological oncology patients that underwent major surgery. Patient variables collected and analysed were BMI (kg/m(2)), length of stay (LOS in days), cancer stage (stage 1 through stage 4), infective complications, non-infective complications and readmission to hospital.
  
  
  
  A total of 300 patients were included in our study, 34 of them were known to be diabetic while 266 were presumed to be non-diabetic. Of the presumed non-diabetic cohort, 17.3 % (46/266) had impaired glucose tolerance or diabetes. Mean BMI was significantly increased in the pre-existing diabetic group (32.8 vs. 29.3 kg/m(2), p = 0.016). Infective complications were almost double the rate amongst the known diabetic women than those presumed to be non-diabetic (32.4 vs. 18.0 %, p = 0.048). Rate of re-admission to hospital due to complications was 20.6 % in the diabetic group and 4.1 % within the presumed non-diabetic group (p < 0.001). Infective complications occurred in 16.9 % of women with HBA1c <42 mmol/mol, 22.7 % of those with HBA1c of 42-47 mmol/mol, 43.5 % of patients with HBA1c 48-64 mmol/mol and 37.5 % of patients with HBA1c >64 mmol/mol. Non-infective complications were also more frequent in women with elevated HBA1c (11.1, 22.7, 26.1 and 12.5 % in those women with HBA1c <42, 42-47, 48-64 and >64 mmol/mol, respectively). Re-admission to hospital within 30 days for a complication of surgery occurred in 4.4 % of women with HBA1c <42 mmol/mol, 4.5 % of women with HBA1c measured at 42-47 mmol/mol, 30.8 % of those with HBA1c 48-64 mmol/mol and 25 % of women with HBA1c >64 mmol/mol.
  
  
  
  Preoperative measurement of HBA1c may identify patients (both diabetic and non-diabetic women) at higher risk of postoperative complications and could be used as a trigger for modification of the perioperative management of such patients.
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK. christosiavazzo@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Iavazzo
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: M
authors.initials: M
authors.lastname: McComiskey
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: M
authors.initials: M
authors.lastname: Datta
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ryan
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: J
authors.initials: J
authors.lastname: Kiernan
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: B
authors.initials: B
authors.lastname: Winter-Roach
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: R
authors.initials: R
authors.lastname: Slade
authors.affiliation: Gynaecological Oncology Department, Christie Hospital, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
authors.forename: M
authors.initials: M
authors.lastname: Smith
mesh_terms: D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D018149:Glucose Intolerance; D006442:Glycated Hemoglobin / Q000032:analysis; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes mellitus; Gynaecological malignancies; HBA1c; Hospital stay; Infection; Non-infective complications