P1071 - IMPACT OF ELEVATED HBA1C ON OUTCOMES IN PATIENTS UNDERGOING GASTROINTESTINAL SURGERY

P1071

IMPACT OF ELEVATED HBA1C ON OUTCOMES IN PATIENTS UNDERGOING GASTROINTESTINAL SURGERY

A. Adiamah^1,*, S. Quraishi¹, T. G. Wong¹, D. Evans², A. Banerjea¹, D. N. Lobo¹ on behalf of The Nottingham University Hospitals HBA1c Working Group

¹Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, ²Anaesthesia, Nottingham University Hospitals and University of Nottingham, Queen’s Medical Centre, Nottingham, United Kingdom

Rationale: Diabetes mellitus is a complex chronic condition associated with adverse health outcomes. Glycated haemoglobin (HbA1c) is commonly used to monitor long-term glycaemic control. Emerging evidence suggests that elevated HbA1c is predictive of poor postoperative outcomes, particularly in vascular and cardiac surgery. This study investigated the association between elevated HbA1c and postoperative outcomes after gastrointestinal surgery.

Methods: This single-centre prospective observational study was conducted at a tertiary hospital. All patients undergoing gastrointestinal surgery between 1 September 2022 and 1 September 2023 with a valid perioperative HbA1c were included. Procedures were categorized as "Intermediate, Major or Complex major" surgery. Patients were stratified by HbA1c status, and primary outcomes were 90-day readmission and 90-day mortality.

Results: A total of 1543 patients (1194 with normal and 349 with elevated HbA1c (≥42mmol/mol)) were included. Higher proportion of patients with raised HbA1c were male (61.32%), older, had higher BMI and more comorbidity (p<0.001). Of those with diabetes, the proportion with a normal HbA1c (well controlled diabetes was 40 (14.7%)). The proportion of patients with HbA1c above the recommended for elective surgery was 48/1495 (3.1%), of these 44/228 had known diabetes and another 4/1267 were unknown diabetes. In multivariate logistic regression controlling for confounders, raised HbA1c was not associated with risk of 90-day readmission (adjusted OR 1.24, 95% CI 0.85-1.83, P = 0.255) or 90-day mortality (adjusted OR 0.52, 95% CI 0.17-1.54, P = 0.234).

Conclusion: Elevated HbA1c in isolation was not associated with an increased risk of 90-day readmission or mortality after gastrointestinal surgery. However, the low proportion of patients with diabetes with normal HbA1c underscores the need for better preoperative optimisation of glycaemic control in this population.

Disclosure of Interest: None declared