Systematic review of the impact of HbA1c on outcomes following surgery in patients with diabetes mellitus

Clinical Nutrition

Volumn 35, Issue 2, 2016, Pages 308-316

  Rollins, Katie E ^a   Varadhan, Krishna K ^a   Dhatariya, Ketan ^b   Lobo, Dileep N ^a  

^a QUEEN S MEDICAL CENTRE   (United Kingdom)

^b NORFOLK AND NORWICH UNIVERSITY HOSPITAL   (United Kingdom)

Author keywords

Complications; Diabetes mellitus; HbA1c; Outcome; Surgery

Indexed keywords

HEMOGLOBIN A1C; GLUCOSE BLOOD LEVEL; GLYCOSYLATED HEMOGLOBIN;

ACUTE CORONARY SYNDROME; ACUTE KIDNEY FAILURE; ADULT; CEREBROVASCULAR ACCIDENT; COMORBIDITY; DIABETES MELLITUS; DIALYSIS; FEMALE; GLYCEMIC CONTROL; HEART ARRHYTHMIA; HOSPITAL READMISSION; HUMAN; INCIDENCE; LENGTH OF STAY; MAJOR CLINICAL STUDY; MALE; MORBIDITY; MORTALITY; POSTOPERATIVE COMPLICATION; PREOPERATIVE PERIOD; PREVALENCE; REOPERATION; RETROSPECTIVE STUDY; REVIEW; RISK FACTOR; SURGICAL INFECTION; SYSTEMATIC REVIEW; VENOUS THROMBOEMBOLISM; ACUTE KIDNEY INJURY; ARRHYTHMIAS, CARDIAC; BLOOD; GLUCOSE BLOOD LEVEL; METABOLISM; OBSERVATIONAL STUDY; POSTOPERATIVE COMPLICATIONS; RISK ASSESSMENT; STROKE; SURGICAL WOUND INFECTION; TREATMENT OUTCOME;

ACUTE CORONARY SYNDROME; ACUTE KIDNEY INJURY; ARRHYTHMIAS, CARDIAC; BLOOD GLUCOSE; DIABETES MELLITUS; HEMOGLOBIN A, GLYCOSYLATED; HUMANS; INCIDENCE; LENGTH OF STAY; MORBIDITY; OBSERVATIONAL STUDIES AS TOPIC; PATIENT READMISSION; POSTOPERATIVE COMPLICATIONS; RISK ASSESSMENT; RISK FACTORS; STROKE; SURGICAL WOUND INFECTION; TREATMENT OUTCOME; VENOUS THROMBOEMBOLISM;

EID: 84960481587     PISSN: 02615614     EISSN: 15321983     Source Type: Journal    
DOI: 10.1016/j.clnu.2015.03.007     Document Type: Review

References (48)

1. Diabetes in the UK 2012. Key statistics on diabetes 2012, Diabetes U.K., Diabetes UK, London, Available at:, [Accessed 10.10.14]. http://www.diabetes.org.uk/Documents/Reports/Diabetes-in-the-UK-2012.pdf.
2. International Diabetes Federation IDF diabetes Atlas 2013, International Diabetes Federation, Brussels, Available at:, [Accessed 09.10.14]. http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf, 6th ed.
3. Dhatariya K., Levy N., Kilvert A., Watson B., Cousins D., Flanagan D., et al. NHS diabetes guideline for the perioperative management of the adult patient with diabetes. Diabet Med 2012, 29:420-433.
4. Wukich D.K., Lowery N.J., McMillen R.L., Frykberg R.G. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Jt Surg Am 2010, 92:287-295.
5. King J.T., Goulet J.L., Perkal M.F., Rosenthal R.A. Gycemic control and infection in patients with diabetes undergoing noncardiac surgery. Ann Surg 2011, 253:158-165.
6. Ata A., Valerian B.T., Lee E.C., Bestle S.L., Elmendorf S.L., Stain S.C. The effect of diabetes mellitus on surgical site infections after colorectal and noncolorectal general surgical operations. Am Surg 2010, 76:697-702.
7. Carson J.L., Scholz P.M., Chen A.Y., Peterson E.D., Gold J., Schneider S.H. Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 2002, 40:418-423.
8. Lobo S.M., Rezende E., Knibel M.F., Silva N.B., Paramo J.A., Nacul F.E., et al. Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg 2011, 112:877-883.
9. Puskas J.D., Winston A.D., Wright C.E., Gott J.P., Brown W.M., Craver J.M., et al. Stroke after coronary artery operation: incidence, correlates, outcome, and cost. Ann Thorac Surg 2000, 69:1053-1056.
10. Ouattara A., Lecomte P., Le Manach Y., Landi M., Jacqueminet S., Platonov I., et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology 2005, 103:687-694.
11. Duncan A.E., Abd-Elsayed A., Maheshwari A., Xu M., Soltesz E., Koch C.G. Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. Anesthesiology 2010, 112:860-871.
12. Sacks D.B., Arnold M., Bakris G.L., Bruns D.E., Horvath A.R., Kirkman M.S., et al. Position statement executive summary: guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care 2011, 34:1419-1423.
13. Bazerbachi F., Nazarian S., Alraiyes A.H., Alraies M.C. Q: Is hemoglobin A1c an accurate measure of glycemic control in all diabetic patients?. Cleve Clin J Med 2014, 81:146-149.
14. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993, 329:977-986.
15. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998, 352:854-865. Erratum in: Lancet 1998; 352: 1558.
16. Stratton I.M., Adler A.I., Neil H.A., Matthews D.R., Manley S.E., Cull C.A., et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321:405-412.
17. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis 2007, 49(2 Suppl 2). S12-S154.
18. Standards of medical care in diabetes Diabetes Care 2013, 36(Suppl 1):S11-S66.
19. National Institute for Clinical Excellence Preoperative tests. The use of routine preoperative tests for elective surgery. Clinical guideline 3 2003, National Institute for Clinical Excellence, London, Available at:, [Accessed 10.10.14]. https://www.nice.org.uk/guidance/cg3/resources/guidance-preoperative-tests-pdf.
20. Halkos M.E., Puskas J.D., Lattouf O.M., Kilgo P., Kerendi F., Song H.K., et al. Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery. J Thorac Cardiovasc Surg 2008, 136:631-640.
21. Engoren M., Schwann T.A., Arslanian-Engoren C., Maile M., Habib R.H. U-shape association between hemoglobin A1c and late mortality in patients with heart failure after cardiac surgery. Am J Cardiol 2013, 111:1209-1213.
22. Halkos M.E., Thourani V.H., Lattouf O.M., Kilgo P., Guyton R.A., Puskas J.D. Preoperative hemoglobin A1c predicts sternal wound infection after coronary artery bypass surgery with bilateral versus single internal thoracic artery grafts. Innov (Phila) 2008, 3:131-138.
23. Gumus F., Polat A., Sinikoglu S.N., Yektas A., Erkalp K., Alagol A. Use of a lower cut-off value for HbA1c to predict postoperative renal complication risk in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2013, 27:1167-1173.
24. Halkos M.E., Lattouf O.M., Puskas J.D., Kilgo P., Cooper W.A., Morris C.D., et al. Elevated preoperative hemoglobin A1c level is associated with reduced long-term survival after coronary artery bypass surgery. Ann Thorac Surg 2008, 86:1431-1437.
25. Humphers J.M., Shibuya N., Fluhman B.L., Jupiter D. The impact of glycosylated hemoglobin and diabetes mellitus on wound-healing complications and infection after foot and ankle surgery. J Am Podiatr Med Assoc 2014, 104:320-329.
26. John W.G. Haemoglobin A1c towards global standardization. Diabet Med 2010, 27:733-734.
27. Hikata T., Iwanami A., Hosogane N., Watanabe K., Ishii K., Nakamura M., et al. High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci 2014, 19:223-228.
28. Jupiter D.C., Humphers J.M., Shibuya N. Trends in postoperative infection rates and their relationship to glycosylated hemoglobin levels in diabetic patients undergoing foot and ankle surgery. J Foot Ankle Surg 2014, 53:307-311.
29. Underwood P., Askari R., Hurwitz S., Chamarthi B., Garg R. Preoperative A1C and clinical outcomes in patients with diabetes undergoing major noncardiac surgical procedures. Diabetes Care 2014, 37:611-616.
30. Adams A.L., Paxton E.W., Wang J.Q., Johnson E.S., Bayliss E.A., Ferrara A., et al. Surgical outcomes of total knee replacement according to diabetes status and glycemic control, 2001 to 2009. J Bone Jt Surg Am 2013, 95:481-487.
31. Strahan S., Harvey R.M., Campbell-Lloyd A., Beller E., Mundy J., Shah P. Diabetic control and coronary artery bypass: effect on short-term outcomes. Asian Cardiovasc Thorac Ann 2013, 21:281-287.
32. Iorio R., Williams K.M., Marcantonio A.J., Specht L.M., Tilzey J.F., Healy W.L. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection. J Arthroplasty 2012, 27:726-729. e1.
33. Myers T.G., Lowery N.J., Frykberg R.G., Wukich D.K. Ankle and hindfoot fusions: comparison of outcomes in patients with and without diabetes. Foot Ankle Int 2012, 33:20-28.
34. Molnar M.Z., Huang E., Hoshino J., Krishnan M., Nissenson A.R., Kovesdy C.P., et al. Association of pretransplant glycemic control with posttransplant outcomes in diabetic kidney transplant recipients. Diabetes Care 2011, 34:2536-2541.
35. Tsuruta R., Miyauchi K., Yamamoto T., Dohi S., Tambara K., Dohi T., et al. Effect of preoperative hemoglobin A1c levels on long-term outcomes for diabetic patients after off-pump coronary artery bypass grafting. J Cardiol 2011, 57:181-186.
36. Knapik P., Ciesla D., Filipiak K., Knapik M., Zembala M. Prevalence and clinical significance of elevated preoperative glycosylated hemoglobin in diabetic patients scheduled for coronary artery surgery. Eur J Cardiothorac Surg 2011, 39:484-489.
37. Sato H., Carvalho G., Sato T., Lattermann R., Matsukawa T., Schricker T. The association of preoperative glycemic control, intraoperative insulin sensitivity, and outcomes after cardiac surgery. J Clin Endocrinol Metab 2010, 95:4338-4344.
38. Acott A.A., Theus S.A., Kim L.T. Long-term glucose control and risk of perioperative complications. Am J Surg 2009, 198:596-599.
39. Lamloum S.M., Mobasher L.A., Karar A.H., Basiony L., Abdallah T.H., Al-Saleh A.I., et al. Relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait. Med Princ Pract 2009, 18:447-452.
40. Matsuura K., Imamaki M., Ishida A., Shimura H., Niitsuma Y., Miyazaki M. Off-pump coronary artery bypass grafting for poorly controlled diabetic patients. Ann Thorac Cardiovasc Surg 2009, 15:18-22.
41. Jones R.N., Marshall W.P. Does the proximity of an amputation, length of time between foot ulcer development and amputation, or glycemic control at the time of amputation affect the mortality rate of people with diabetes who undergo an amputation?. Adv Skin Wound Care 2008, 21:118-123.
42. O'Sullivan C.J., Hynes N., Mahendran B., Andrews E.J., Avalos G., Tawfik S., et al. Haemoglobin A1c (HbA1c) in non-diabetic and diabetic vascular patients. Is HbA1C an independent risk factor and predictor of adverse outcome?. Eur J Vasc Endovasc Surg 2006, 32:188-197.
43. Dronge A.S., Perkal M.F., Kancir S., Concato J., Aslan M., Rosenthal R.A. Long-term glycemic control and postoperative infectious complications. Arch Surg 2006, 141:375-380. discussion 380.
44. Latham R., Lancaster A.D., Covington J.F., Pirolo J.S., Thomas C.S. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol 2001, 22:607-612.
45. Bishop J.R., Moul J.W., Sihelnik S.A., Peppas D.S., Gormley T.S., McLeod D.G. Use of glycosylated hemoglobin to identify diabetics at high risk for penile periprosthetic infections. J Urol 1992, 147:386-388.
46. Kwon S., Thompson R., Dellinger P., Yanez D., Farrohki E., Flum D. Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Ann Surg 2013, 257:8-14.
47. Skyler J.S., Bergenstal R., Bonow R.O., Buse J., Deedwania P., Gale E.A., et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA Diabetes Trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol 2009, 53:298-304.
48. Gerstein H.C., Miller M.E., Byington R.P., Goff D.C., Bigger J.T., Buse J.B., et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008, 358:2545-2559.