The most effective long-term treatment for diabetes in patients with severe obesity is bariatric surgery. After any gastrointestinal surgery, complication rates are higher in patients with uncontrolled diabetes. This project assessed the association between pre-operative HbA1C and post-operative complications for bariatric surgery patients at a safety-net institution.
Using electronic medical record (EMR) data, a chart review was performed of patients who had bariatric surgery from 2015-2018 and had a HbA1c in the 12 months prior to surgery. Demographic data and 1-year post-operative complication rate were assessed. Chi square and Wilcoxon tests were conducted for bivariable analysis of categorical and continuous variables, respectively. Multivariate logistic regression analysis was performed for testing effect of HA1c after adjustment.
363 patients had bariatric surgery and had a HbA1c test pre-operatively; the average age was 47 years; 86% were female, the mean BMI was 49. HbA1c was: <7 in 84%; 7-8 in 10%; >8 in 6%. The overall rate of any complication was 15.7%. Demographic characteristics, BMI and HbA1c were not predictive of complication rate(P>0.05).
Neither patient characteristics nor level of glycemic control correlated with rates of post-operative complications in this sample of bariatric patients from a safety-net system. These results are limited by the very low number of patients with a hemoglobin A1c >8%. Broader assessments of the impact of uncontrolled diabetes on bariatric surgical safety should be done to balance the risk of surgery with the risk of delaying surgical treatment of diabetes