Morbidity And Mortality of Gastric Sleeve and Bypass Patients With Elevated HBA1C Levels

Abstract

Background: Over the past several decades, laparoscopic Roux-en-Y gastric bypass and vertical sleeve gastrectomy offer excellent surgical options in the management of obesity as well as diabetes mellitus type 2. As the popularity of these procedures increase, it becomes necessary to determine the risk-benefit when selecting patients for these surgeries. The purpose of this study is to analyze the effect of elevated pre-operative HbA1c within the patient population undergoing these procedures and how it affects post-operative success, recovery, and complications. Methods: This is a retrospective cohort study with patients recruited from the Loma Linda University Healthcare Bariatric Surgery database. Data was collected from patients that received either the gastric sleeve or bypass procedure from July 2012 to July 2015. Inclusion criteria are patients above the age of 18 who underwent laparoscopic vertical sleeve gastrectomy or laparo-scopic Roux-en-Y gastric bypass. Patients were excluded if younger than 18 years, lost to follow-up within 30 days after surgery, or did not have any recorded HbA1c values within 6 months prior to surgery. Patients were separated into 3 groups determined by their HbA1c level, either below 6.5 mg/dL (Group A), between 6.5-8.0 mg/dL (Group B), and above 8.0 mg/dL (Group C). Follow-up was continued on all groups for a minimum of 1 year. The 3 groups were then analyzed using the Chi-Square method for complication rates, operative success, and postoperative HbA1c changes. Complications were graded as either early (within 30 days) or late (after 30 days), as well as major or minor. Major complications were assessed as reoperation, wound infection, leak, venous thrombosis, or death. All other complications were deemed minor. Results: A total of 192 pts were collected, 138 in Group A, 33 in Group B, and 21 in Group C. Group A demonstrated a 22/138 (15.9%) complication rate, Group B had 6/33 (18.2%), and Group C had 3/21 (14.3%). The overall complication rate from the procedures was 31/192 (18.2%). 10 (5.2%) of the complications were major complications, including 6 wound infections, 1 DVT, 1 leak, and 2 anastomotic strictures, there were no deaths. 21 (10.9%) of the complications were minor, including dehydration, nausea, emesis, and diarrhea. 21 of the complications were early, and 14 were late. The chi-square statistic for the study is 0.2216, with a p-value of 0.895106. This shows no significance in the results between the groups. Conclusion: Our study showed no significant difference in morbidity outcomes major or minor in patients with poorly controlled diabetes versus patients with either well controlled diabetes or none at all. This indicates that patients with HbA1c 4 8.0 mg/dL can safely undergo these surgical procedures without any increased risk in morbidity or mortality. The lack of significance indicates that weight loss surgery should not be unnecessarily delayed for patients with poorly controlled diabetes, as the long term efficacy of the surgery has proven benefits. The study can be strengthened by factoring in long term efficacy of weight loss surgery and its effect on diabetes management. Limitations of this study include short duration of follow-up (1 year), small sample size, as well as its retrospective nature. Patients with poorly controlled diabetes with a multidisciplinary team approach including endocrinologists can safely and effec-tively undergo bariatric surgery.