Association of Elevated Pre‐operative Hemoglobin A1c and Post‐operative Complications in Non‐diabetic Patients: A Systematic Review

Karimian, Negar; Niculiseanu, Petru; Amar‐Zifkin, Alexandre; Carli, Francesco; Feldman, Liane S.

doi:10.1007/s00268-017-4106-4

Cited by 31 publications

(21 citation statements)

References 75 publications

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“…Our results might be influenced by the different definitions of higher and lower HbA1c levels in the included original studies. For nondiabetic patients, the results of this systematic review were consistent with those of a previous systematic review [51].…”

supporting

confidence: 88%

Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis

Wang

Luo

Jin

et al. 2020

Journal of Diabetes Research

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Aims. To investigate the effect of preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgery in diabetic and nondiabetic patients. Methods and Results. The MEDLINE (via PubMed), Cochrane Library, Web of Science, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) databases were used to search the effects of different preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients from inception to December 2018. Two review authors worked in an independent and duplicate manner to select eligible studies, extract data, and assess the risk of bias of the included studies. We used a meta-analysis to synthesize data and analyze subgroups, sensitivity, and publication bias as well as the GRADE methodology if appropriate. The literature search retrieved 886 records initially, and 23 cohort studies were included in the meta-analysis. In this meta-analysis, we found that there was a reduced incidence of surgical site infections (OR=2.94, 95% CI 2.18-3.98), renal failure events (OR=1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR=1.69, 95% CI 1.16-2.47), as well as a shortened hospital stay (MD=1.08, 95% CI 0.46-1.71), in diabetic patients after coronary artery disease surgical treatment with lower preoperative HbA1c levels. For nondiabetic patients, a higher preoperative HbA1c level resulted in an increase in the incidence of mortality (OR=2.23, 95% CI 1.01-4.90) and renal failure (OR=2.33, 95% CI 1.32-4.12). No significant difference was found between higher and lower preoperative HbA1c levels in the incidence of mortality (OR=1.06, 95% CI 0.88-1.26), stroke (OR=1.49, 95% CI 0.94-2.37), or atrial fibrillation (OR=0.94, 95% CI 0.67-1.33); the length of ICU stay (MD=0.20, 95% CI -0.14-0.55); or sepsis incidence (OR=2.49, 95% CI 0.99-6.25) for diabetic patients or for myocardial infarction events (OR=1.32, 95% CI 0.27-6.31) or atrial fibrillation events (OR=0.99, 95% CI 0.74-1.33) for nondiabetic patients. The certainty of evidence was judged to be moderate or low. Conclusion. This meta-analysis showed that higher preoperative HbA1c levels may potentially increase the risk of surgical site infections, renal failure, and myocardial infarction and reduce the length of hospital stay in diabetic subjects after coronary artery disease surgical treatment and increase the risk of mortality and renal failure in nondiabetic patients. However, there was great inconsistency in defining higher preoperative HbA1c levels in the studies included; we still need high-quality RCTs with a sufficiently large sample size to further investigate this issue in the future. This trial is registered with CRD42019121531.

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confidence: 88%

Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis

Wang

Luo

Jin

et al. 2020

Journal of Diabetes Research

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“…It remains questionable whether high preoperative HbA1c levels in presumed non-diabetic patients are association with unfavorable outcome. In a systematic review, six retrospective and prospective cohort studies were evaluated whether preoperative HbA1c might be indicative for non-diabetic patients at risk of postoperative complications [7]. HbA1c cut-off levels for the prediction of complications ranged from 5.7 to 7%, showing that higher HbA1c levels were related to 30-day postoperative complications, including acute kidney injury, cardiovascular and pulmonary complications, but not with infections [7].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a preoperative elevated HbA1c is associated with higher mean postoperative glucose levels in patients with no diabetic history [6]. A systematic review showed that a high preoperative HbA1c (> 6%) in non-diabetic subjects was associated with an increased risk of overall postoperative complications, but this association may vary among specific populations [7].…”

Section: Introductionmentioning

confidence: 99%

Level of agreement of point-of-care and laboratory HbA1c measurements in the preoperative outpatient clinic in non-diabetic patients who are overweight or obese

Raalten

Hiemstra

Keulen

et al. 2019

J Clin Monit Comput

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Implementation of point-of-care HbA1c devices in the preoperative outpatient clinic might facilitate the early diagnosis of glycemic disturbances in overweight or obese patients undergoing surgery, but validation studies in this setting do not exist. We determined the level of agreement between a point-of-care and laboratory HbA1c test in non-diabetic patients visiting the outpatient clinic for preoperative risk profiling. Point-of-care HbA1c levels were measured in whole blood obtained by a finger prick (Siemens DCA Vantage HbA1c analyzer) and in hemolysed EDTA blood in the central laboratory (LAB). Bland Altman and Clarke’s error grid analysis were used to analyze the agreement between the point-of-care and laboratory measurements. Patients (n = 49) were 55 ± 11 years old, 47% were male with a body mass index (BMI) of 30.6 ± 3.4 kg/m2. The mean HbA1c was 38.1 ± 3.7 mmol/mol or 5.6 ± 0.3%. One patient was diagnosed with a HbA1c indicative for diabetes mellitus (6.7%). Bland Altman analysis revealed a bias of − 0.53 ± 1.81 mmol/mol with limits of agreement of − 4.09 to 3.03 mmol/mol and a bias of − 0.05 ± 0.17% with limits of agreement − 0.39 to 0.28%. The percentage error was 9.2% and 5.9% for HbA1c expressed in mmol/mol and %, respectively. Clarke’s error grid analysis showed that 48 out of 49 measurements were located in area A (98%). Point-of-care HbA1c measurements showed a high level of agreement with the laboratory test in the outpatient setting, and may be used for preoperative risk profiling in patients prone to cardiometabolic complications.Trial registration: Netherlands Trial Register NTR3057.

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“…To evaluate 2001-2013 evidence that preoperative testing of blood glucose and HgbA1c might affect outcome measures in elective non-cardiac surgery, a systematic review concluded that preoperative blood glucose and HgbA1c tests are only indicated in non-diabetic patients upon clinical situation of an abnormality or elevated risk such as vascular and orthopedic surgery (233). A systematic review of observational studies of non-diabetic patients with elevated preoperative HgbA1c showed increased post-operative complications in non-diabetic patients in four of the six reports, lending support for use of suboptimal HgbA1c levels as a modifiable marker of adverse post-operative outcomes (234). As noted by the authors of these systematic reviews, limitations relate to the paucity of high-quality studies, lack of randomized controlled trials, and high heterogeneity of available studies.…”

Section: Pre-surgical Assessmentmentioning

confidence: 99%

Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin

Yee¹,

Mortimer²,

Natarajan³

et al. 2020

Front. Endocrinol.

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The potential association between obesity and TNBC has been a subject of intense research study. As outlined below, studies investigating the potential relationship between obesity and TNBC have been inconsistent. This is a summary of some of the key studies that have been recently published.The Carolina Breast Cancer Study is a North Carolina population-based case-controlled study of breast cancer, conducted in three phases (28). The current study phase, Phase 3 (years 2008-2014), includes women resident in 44 North Carolina Counties (28), employing randomized recruitment to oversample African-American/Black women and women under age 50 (28). Waist to hip ratio (WHR) was compared between the highest (≥0.84) and lowest (<0.77) groups vs. the basal-type subset of TNBC. There was an increased risk [odds ratio (OR) = 2.3; 95% CI, 1.4-3.6] for basal-type TNBC in women with higher WHR (43). Premenopausal women (OR = 1.8; 95% CI, 1.0-3.4) and post-menopausal women (OR = 2.7; 95% CI, 1.3-5.4) with the highest WHR had increased risk of developing basal-type TNBC compared to the lowest WHR (43). Basal-type breast cancer was observed to be highest among premenopausal African-American/Black women (43). There was no significant association between increased BMI (defined as BMI ≥ 25 kg/m 2 ) and basal-type TNBC.The Appalachian Study investigated the potential association between obesity (defined as BMI ≥ 30 kg/m 2 ) and TNBC in 620 predominantly non-Hispanic White women in rural Appalachia. This study reported a significant association between obesity and the incidence of TNBC (29).Women's CARE study is a case-controlled study of BMI and breast cancer risk in non-Hispanic White women and African-American/Black women. The Women's CARE study reported (1) an inverse association between a woman's BMI at age 18 and premenopausal ER-/PR-breast cancer and (2) a positive association between current BMI and post-menopausal ER+/PR+ breast cancer (30).

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Association of Elevated Pre‐operative Hemoglobin A1c and Post‐operative Complications in Non‐diabetic Patients: A Systematic Review

Abstract: Based on the limited available evidence, suboptimal pre-operative HbA1c levels in patients with no prior history of diabetes predict post-operative complications and represent a potentially modifiable risk factor.

Cited by 31 publications

References 75 publications

Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis

Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis

Level of agreement of point-of-care and laboratory HbA1c measurements in the preoperative outpatient clinic in non-diabetic patients who are overweight or obese

Metabolic Health, Insulin, and Breast Cancer: Why Oncologists Should Care About Insulin

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