The Relation of Preoperative HbA1c Level With Intraoperative and Postoperative Complications in Type-2 Diabetic Patients: An Observational Study

Dhananj Shivganesh B R; Habib Md R Karim; Nandkishore Agrawal; Mayank Kumar

doi:10.7759/cureus.64487

The Relation of Preoperative HbA1c Level With Intraoperative and Postoperative Complications in Type-2 Diabetic Patients: An Observational Study

Cureus. 2024 Jul 13;16(7):e64487. doi: 10.7759/cureus.64487. eCollection 2024 Jul.

Authors

Dhananj Shivganesh B R¹, Habib Md R Karim², Nandkishore Agrawal³, Mayank Kumar³

Affiliations

¹ Anesthesiology and Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, IND.
² Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Guwahati, IND.
³ Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Raipur, IND.

Abstract

Background Perioperative dysglycemia increases morbidity and mortality, particularly among those with diabetes mellitus (DM), and elevated HbA1c levels, reflecting long-term blood glucose, are linked to poor healing and higher infection rates. This study investigates the link between preoperative HbA1c levels and perioperative outcomes in type-2 DM patients. Methodology This prospective observational study was conducted in India between January 2021 and April 2022. Sixty patients aged 18-60 with type-2 DM who underwent elective surgery under general anesthesia (GA) were included; the American Society of Anesthesiologists class >III and patients with severe organ failures were excluded. Participants were divided into two groups: A (HbA1c ≤7.5%) and B (HbA1c >7.5%). Data on preoperative vitals, intraoperative hemodynamics, and postoperative complications were collected. SPSS v23 was used for data analysis; p-value <0.05 was considered significant. Results The mean age of the participants was 48.22 years; males comprised 58.3%. Group A had a higher proportion of oral hypoglycemic agents. Group B showed higher maximum mean blood pressure and intraoperative blood sugar levels at one hour. Postoperatively, Group B had higher glucose levels, more prevalent hyperglycemia, and higher preoperative and postoperative blood urea levels. No significant differences were found in postoperative outcomes like acute kidney injury (AKI), leukocytopenia, leucocytosis, fever, and intensive care admission. Surgical site infection (SSI) incidence was higher in group B, though not statistically significant. Group B had more extended hospital stays. Conclusion Preoperative HbA1c above 7.5% was associated with impaired perioperative glycemic control and higher dysglycemic episodes. Higher preoperative HbA1c was found to be linked to increased postoperative hyperglycemia, AKI, intensive care admissions, and more extended hospital stays, though not statistically significant. SSI incidence was higher, highlighting its importance over preoperative HbA1c.

Keywords: diabetes; elective general surgery; glycemic control; hba1c; hyperglycemia; perioperative complications.