Association of elevated pre-operative HbA1c and post-operative complications in patients undergoing gynaecological oncology surgery

J Obstet Gynaecol. 2020 Oct;40(7):994-999. doi: 10.1080/01443615.2019.1678577. Epub 2019 Dec 11.

Abstract

HbA1c testing provides average blood glucose control, an elevated result may be associated with adverse post-operative outcomes. Our objective was to evaluate the association between elevated pre-operative HbA1c and post-operative complications in patients undergoing major gynaecological oncology surgery. HbA1c was measured pre-operatively in 364 patients. We identified 65 (16%) patients at risk of developing diabetes with borderline HbA1c measurements.Patients with borderline HbA1c (42-47 mmol/mol) had almost double the incidence of infections compared to patients with normal HbA1c (15.8% vs. 6.5%, p=.038). There were significantly less infections between patients with a normal HbA1c (<42 mmol/mol) and those with an HbA1c of over 42 mmol/mol (6.5% vs. 22.8%, p<.05). There was an association between elevated HbA1c and infective complications especially in patients with a borderline HbA1c. It is suggested that knowing HbA1c status, intervention can be made to prevent post-operative infective complications and improve outcomes.Impact statementWhat is already known on this subject? Obesity is a common risk factor for gynaecological cancer and elevated HbA1c. Chronically elevated HbA1c may lower immunity. An association has been shown previously between elevated HbA1c and post-operative complications.What the results of this study add? This study examined infective complications in patients undergoing gynaecological surgery; showing that patients with a borderline HbA1c (42-47 mmol/mol), especially those with a diagnosis of diabetes to be most at risk. This suggests that pre-operative HbA1c should be used routinely to guide care rather than diabetic status alone to prevent post-operative infections.What the implications are of these findings for clinical practice and/or further research? More research needs to be carried out to find the optimal pre-operative HbA1c targets to reduce post-operative infection rates. Work needs to be done in conjunction with general practitioners to help patients to reduce their HbA1c prior to treatment.

Keywords: HbA1c; complications; gynaecological; oncology; post-operative; surgery.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Diabetes Mellitus / epidemiology
  • Female
  • Genital Neoplasms, Female / epidemiology
  • Genital Neoplasms, Female / surgery*
  • Glycated Hemoglobin / analysis*
  • Glycemic Control
  • Humans
  • Infections / blood
  • Infections / epidemiology
  • Middle Aged
  • Obesity / blood
  • Obesity / epidemiology
  • Postoperative Complications / blood*
  • Postoperative Complications / epidemiology
  • Preoperative Period*
  • Retrospective Studies

Substances

  • Glycated Hemoglobin A