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    Association of elevated pre-operative HbA1c and post-operative complications in patients undergoing gynaecological oncology surgery

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    Authors
    Keavy, Emily
    Sizer, Edward
    Datta, Meghna
    Ryan, Margaret
    Bradley, Laura
    Smith, Michael
    Winter-Roach, Brett
    Slade, Richard J
    Myriokefalitaki, Eva
    Affiliation
    Gynaecological Oncology, Surgery, The Christie Hospital NHS FT, The University of Manchester, Manchester
    Issue Date
    2019
    
    Metadata
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    Abstract
    HbA1c testing provides average blood glucose control, an elevated result may be associated with adverse post-operative outcomes. Our objective was to evaluate the association between elevated pre-operative HbA1c and post-operative complications in patients undergoing major gynaecological oncology surgery. HbA1c was measured pre-operatively in 364 patients. We identified 65 (16%) patients at risk of developing diabetes with borderline HbA1c measurements.Patients with borderline HbA1c (42-47?mmol/mol) had almost double the incidence of infections compared to patients with normal HbA1c (15.8% vs. 6.5%, p=.038). There were significantly less infections between patients with a normal HbA1c (<42?mmol/mol) and those with an HbA1c of over 42?mmol/mol (6.5% vs. 22.8%, p<.05). There was an association between elevated HbA1c and infective complications especially in patients with a borderline HbA1c. It is suggested that knowing HbA1c status, intervention can be made to prevent post-operative infective complications and improve outcomes.Impact statementWhat is already known on this subject? Obesity is a common risk factor for gynaecological cancer and elevated HbA1c. Chronically elevated HbA1c may lower immunity. An association has been shown previously between elevated HbA1c and post-operative complications.What the results of this study add? This study examined infective complications in patients undergoing gynaecological surgery; showing that patients with a borderline HbA1c (42-47 mmol/mol), especially those with a diagnosis of diabetes to be most at risk. This suggests that pre-operative HbA1c should be used routinely to guide care rather than diabetic status alone to prevent post-operative infections.What the implications are of these findings for clinical practice and/or further research? More research needs to be carried out to find the optimal pre-operative HbA1c targets to reduce post-operative infection rates. Work needs to be done in conjunction with general practitioners to help patients to reduce their HbA1c prior to treatment.
    Citation
    Keavy E, Sizer E, Datta M, Ryan M, Bradley L, Smith M, et al. Association of elevated pre-operative HbA1c and post-operative complications in patients undergoing gynaecological oncology surgery. J Obstet Gynaecol. 2019:1-6.
    Journal
    Journal of obstetrics and gynaecology
    URI
    http://hdl.handle.net/10541/622659
    DOI
    10.1080/01443615.2019.1678577
    PubMed ID
    31825268
    Additional Links
    https://dx.doi.org/10.1080/01443615.2019.1678577
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1080/01443615.2019.1678577
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