Comparison of Outcomes in Revisional Bariatric Surgery in Patients with Elevated Hemoglobin A1c

Introduction: Elevated glycosylated hemoglobin (HbA1c) is a modifiable risk factor for postoperative complication. However, in bariatric surgery, as published by our group and others, elevated preoperative HbA1c may not be associated with increased postoperative complication. The objective of this study was to assess the impact of HbA1c on early postoperative outcomes in revisional bariatric surgery patients as they are considered higher risk. Methods: Revisional stapled bariatric surgery patients between 2017 and 2018 were selected for a retrospective review from the MBSAQIP database. The study population of 11,959 patients were analyzed for our primary outcome of a composite of any postoperative complication occurring within 30-days. HbA1c cutoff values of 8% and 10% were used. Propensity score matching (PSM) was used with one-to-one matching. Complication rates before and after PSM were calculated and assessed by Fisher’s exact test and conditional logistic regression, respectively. Results: After PSM, elevated HbA1C was not associated with worse outcomes. There was no significant difference seen in the composite outcomes for HbA1C ≤8 vs HbA1C >8 (p = 0.22) or for patients with HbA1C ≤10 vs HbA1C >10 (p <0.46). There was no difference in individual outcomes like surgical site infections, cardiopulmonary complication, or readmission/reintervention. Conclusion: In this study of revisional bariatric patients, which are considered higher surgical risk compared with primary procedures, elevated HbA1c >8% or 10% was not associated with increased postoperative complication. Prospective studies are needed to investigate this further.