CoChat
Sign Up
Cited by 13Cardiac, Anesthesia and Surgical OutcomesHyperglycemia and glycemic control in critically ill and hospitalized patientsEnhanced Recovery After Surgery

Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic review

Open access
Yu, Abby, Truong, Quynh, Whitfield, Karen, Hale, Andrew, Taing, Meng‐Wong, Barker, Natalie, D’Emden, Michael·2024·Diabetic Medicine
DOI 10.1111/dme.15380
Open this paper in CoChat — free accountOpen PDF

Abstract

Aims: Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A 1c (HbA 1c) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA 1c levels on postoperative outcomes in adults who had undergone major noncardiac surgery. Methods: We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case–control studies) which measured HbA 1c within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA 1c as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946). Results: Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA 1c levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA 1c was associated with increased odds of these complications. No association with reoperations and 30‐day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism. Conclusions: Current evidence suggested that higher preoperative HbA 1c levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. Further high‐quality studies would be needed to quantify the risks posed and determine whether early intervention improves outcomes.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/dme.15380

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Current data suggest an optimal A1C goal between 7% and 8% preoperatively, as it is associated with better glycemic management in the perioperative period and decreased length of hospital stay.

    “Current data also suggest an optimal A1C goal between 7% and 8% preoperatively, as it is associated with better glycemic management in the perioperative period and decreased length of hospital stay (139,141-144).”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [143]

    The Discussion reports that higher preoperative HbA1c was associated with higher postoperative glucose, and §3.8.1 reports that three of four studies linked higher HbA1c to longer hospital stays. But the review does not establish 7%–8% as an optimal preoperative goal: one study found longer stays at HbA1c ≥7%, while another found shorter stays in a 6.5%–8% group than in a >8% group. No page numbers are available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 43

  1. Dagogo-Jack S, Alberti KGMM. Management of Diabetes Mellitus in surgical patients. Diabetes Spectr. 2002;15(1):44-48. doi:10.2337/diaspect.15.1.44 · DOI
  2. Luo W, Sun RX, Jiang H, Ma XL. The effect of diabetes on perioperative complications following spinal surgery: a meta- analysis. Ther Clin Risk Manag. 2018;14:2415-2423. doi:10.2147/ tcrm.S185221 · DOI
  3. Tan DJH, Yaow CYL, Mok HT, et al. The influence of dia- betes on postoperative complications following colorectal surgery. Tech Coloproctol. 2021;25(3):267-278. doi:10.1007/ s10151-020-02373-9 · DOI
  4. Chen EB, Nooromid MJ, Helenowski IB, Soper NJ, Halverson AL. The relationship of preoperative versus postoperative hyper- glycemia on clinical outcomes after elective colorectal surgery. Surgery. 2019;166(4):655-662. doi:10.1016/j.surg.2019.04.043 · DOI
  5. Showen A, Russell TA, Young S, Gupta S, Gibbons MM. Hyperglycemia is associated with surgical site infections among general and vascular surgery patients. Am Surg. 2017;83(10):1108-1111. doi:10.1177/000313481708301019 · DOI
  6. Buehler L, Fayfman M, Alexopoulos AS, et al. The impact of hyperglycemia and obesity on hospitalization costs and clini- cal outcome in general surgery patients. J Diabetes Complicat. 2015;29(8):1177-1182. doi:10.1016/j.jdiacomp.2015.07.027 · DOI
  7. Gustafsson UO, Thorell A, Soop M, Ljungqvist O, Nygren J. Haemoglobin A 1c as a predictor of postoperative hyperglycae- mia and complications after major colorectal surgery. Br J Surg. 2009;96(11):1358-1364. doi:10.1002/bjs.6724 · DOI
  8. d'Emden MC, Shaw JE, Colman PG, et al. The role of HbA 1c in the diagnosis of diabetes mellitus in Australia. Med J Aust. 2012;197(4):220-221. doi:10.5694/mja12.10988 · DOI
  9. Wang J, Luo X, Jin X, et al. Effects of preoperative HbA 1c levels on the postoperative outcomes of coronary artery disease surgi- cal treatment in patients with diabetes mellitus and nondiabetic patients: a systematic review and meta-analysis. J Diabetes Res. 2020;2020:3547491. doi:10.1155/2020/3547491 · DOI
  10. Zheng J, Cheng J, Wang T, Zhang Q, Xiao X. Does HbA 1c level have clinical implications in diabetic patients undergoing coronary ar- tery bypass grafting? A systematic review and meta-analysis. Int J Endocrinol. 2017;2017:1537213. doi:10.1155/2017/1537213 · DOI
  11. Blankush JM, Leitman IM, Soleiman A, Tran T. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery. Ann Med Surg (Lond). 2016;10:77-82. doi:10.1016/j.amsu.2016.07.025 · DOI
  12. Keavy E, Sizer E, Datta M, et al. Association of elevated pre- operative HbA 1c and post-operative complications in patients undergoing gynaecological oncology surgery. J Obstet Gynaecol. 2020;40(7):994-999. doi:10.1080/01443615.2019.1678577 · DOI
  13. Rollins KE, Varadhan KK, Dhatariya K, Lobo DN. Systematic review of the impact of HbA 1c on outcomes following surgery in patients with diabetes mellitus. Clin Nutr. 2016;35(2):308- 316. doi:10.1016/j.clnu.2015.03.007 · DOI
  14. Bock M, Johansson T, Fritsch G, et al. The impact of preoperative testing for blood glucose concentration and haemoglobin A 1c on mortality, changes in management and complications in non- cardiac elective surgery: a systematic review. Eur J Anaesthesiol. 2015;32(3):152-159. doi:10.1097/eja.0000000000000117 · DOI
  15. Tao X, Matur AV, Palmisciano P, et al. Preoperative HbA 1c and postoperative outcomes in spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2023;48(16):1155- 1165. doi:10.1097/brs.0000000000004703 · DOI · Paper page
  16. Prus K, Akça B, Bilotta F. Preoperative glycated hemoglobin con- centration and early postoperative infections in patients under- going spinal surgery: a systematic review. Clin Neurol Neurosurg. 2023;233:107938. doi:10.1016/j.clineuro.2023.107938 · DOI
  17. Shohat N, Muhsen K, Gilat R, Rondon AJ, Chen AF, Parvizi J. Inadequate glycemic control is associated with increased sur- gical site infection in Total joint arthroplasty: a systematic re- view and meta-analysis. J Arthroplast. 2018;33(7):2312-2321.e3. doi:10.1016/j.arth.2018.02.020 · DOI
  18. Covidence. Systematic review software. www. covid ence. org
  19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205- 213. doi:10.1097/01.sla.0000133083.54934.ae · DOI · Paper page
  20. Mamikutty R, Aly AS, Marhazlinda J. Selecting risk of bias tools for observational studies for a systematic review of anthropomet- ric measurements and dental caries among children. Int J Environ Res Public Health. 2021;18(16):8623. doi:10.3390/ijerph18168623 · DOI
  21. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospi- tal mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368-1375. doi:10.1056/NEJMsa0903048 · DOI
  22. Kim DJ, Lee JH, Kim W. Comparison of the major postoperative complications between laparoscopic distal and total gastrecto- mies for gastric cancer using Clavien-Dindo classification. Surg Endosc. 2015;29(11):3196-3204. doi:10.1007/s00464-014-4053-1 · DOI
  23. van den Boom W, Schroeder RA, Manning MW, Setji TL, Fiestan GO, Dunson DB. Effect of A1c and glucose on postop- erative mortality in noncardiac and cardiac surgeries. Diabetes Care. 2018;41(4):782-788. doi:10.2337/dc17-2232 · DOI · Paper page
  24. Chen Z, Ding S, Yuan Y, Du J, Zhang L. Relationship between perioperative cardiovascular events and glycated hemoglobin in diabetic patients undergoing noncardiac surgery. Biomed Res Int. 2020;2020:3645374. doi:10.1155/2020/3645374 · DOI
  25. Cheong C, Golder A, Horgan P, Roxburgh C, McMillan D. Relationship between pre-operative glycated haemoglobin and surgical site infection in patients undergoing elective colon can- cer surgery. Oncol Lett. 2022;24(3):1. doi:10.3892/ol.2022.13416 · DOI
  26. Godshaw BM, Ojard CA, Adams TM, Chimento GF, Mohammed A, Waddell BS. Preoperative glycemic control predicts periop- erative serum glucose levels in patients undergoing Total joint arthroplasty. J Arthroplast. 2018;33(7s):S76-s80. doi:10.1016/j. arth.2018.02.071 · DOI
  27. Goldstein DT, Durinka JB, Martino N, Shilling JW. Effect of preoperative hemoglobin a( 1c ) level on acute postoperative complications of total joint arthroplasty. Am J Orthop (Belle Mead NJ). 2013;42(10):E88-E90.
  28. Gray M, Singh S, Zucker SD. Influence of type 2 diabetes mel- litus and preoperative hemoglobin A 1c levels on outcomes of liver transplantation. Hepatol Commun. 2019;3(4):574-586. doi:10.1002/hep4.1323 · DOI
  29. Humphers J, Shibuya N, Fluhman BL, Jupiter D. The im- pact of glycosylated hemoglobin and diabetes mellitus on postoperative wound healing complications and infection following foot and ankle surgery. J Am Podiatr Med Assoc. 2014;104(4):140626130507002. doi:10.7547/0003-0538-104.4.320 · DOI
  30. Iavazzo C, McComiskey M, Datta M, et al. Preoperative HBA 1c and risk of postoperative complications in patients with gy- naecological cancer. Arch Gynecol Obstet. 2016;294(1):161-164. doi:10.1007/s00404-015-3983-8 · DOI
  31. Jones CE, Graham LA, Morris MS, et al. Association between preoperative hemoglobin A 1c levels, postoperative hyperglyce- mia, and readmissions following gastrointestinal surgery. JAMA Surg. 2017;152(11):1031-1038. doi:10.1001/jamasurg.2017.2350 · DOI · Paper page
  32. Okamura A, Watanabe M, Imamura Y, et al. Preoperative gly- cosylated hemoglobin levels predict anastomotic leak after Esophagectomy with cervical Esophagogastric anastomosis. World J Surg. 2017;41(1):200-207. doi:10.1007/s00268-016-3763-z · DOI
  33. Okamura A, Yamamoto H, Watanabe M, et al. Association between preoperative HbA 1c levels and complications after Esophagectomy: analysis of 15,801 Esophagectomies from the National Clinical Database in Japan. Ann Surg. 2022;276(5):e39 3-e399. doi:10.1097/sla.0000000000004547 · DOI
  34. Ringel NE, Morgan DM, Kamdar N, Gutman RE. Hysterectomy complications relative to HbA( 1c ) levels: identifying a threshold for surgical planning. J Minim Invasive Gynecol. 2021;28(10):1735-1742.e1. doi:10.1016/j.jmig.2021.02.010 · DOI
  35. Ringel NE, de Winter KL, Siddique M, et al. Surgical outcomes in Urogynecology-assessment of perioperative and postopera- tive complications relative to preoperative hemoglobin A 1c -a fel- lows pelvic research network study. Female Pelvic Med Reconstr Surg. 2022;28(1):7-13. doi:10.1097/spv.0000000000001057 · DOI
  36. Singh N, Zeng C, Lewinger JP, et al. Preoperative hemoglo- bin A 1c levels and increased risk of adverse limb events in diabetic patients undergoing infrainguinal lower extremity bypass surgery in the vascular quality initiative. J Vasc Surg. 2019;70(4):1225-1234.e1. doi:10.1016/j.jvs.2018.12.041 · DOI
  37. Tanaka T, Bradford T, Litofsky NS. Severity of preoperative HbA 1c and predicting postoperative complications in spine surgery. World Neurosurg. 2021;155:e770-e777. doi:10.1016/j. wneu.2021.08.133 · DOI
  38. Underwood P, Askari R, Hurwitz S, Chamarthi B, Garg R. Preoperative A 1c and clinical outcomes in patients with diabe- tes undergoing major noncardiac surgical procedures. Diabetes Care. 2014;37(3):611-616. doi:10.2337/dc13-1929 · DOI · Paper page
  39. Wu L-P, Pang K, Li B, Le Y, Tang Y-Z. Predictive value of gly- cosylated hemoglobin for post-operative acute kidney injury in non-cardiac surgery patients. Front Med. 2022;9:886210. doi:10.3389/fmed.2022.886210 · DOI
  40. Hirano Y, Fujita T, Konishi T, et al. Impact of pre-diabetes, well-controlled diabetes, and poorly controlled diabetes on anastomotic leakage after esophagectomy for esophageal can- cer: a two-center retrospective cohort study of 1901 patients. Esophagus. 2023;20(2):246-255. doi:10.1007/s10388-022-00965-y · DOI
  41. Kulikov A, Krovko Y, Zagidullin T, Ershova O, Bilotta F. Association of Preoperative Glycated Hemoglobin and Early Postoperative Infections after Elective Craniotomy: a retro- spective cohort study. World Neurosurg. 2023;175:e505-e510. doi:10.1016/j.wneu.2023.03.132 · DOI
  42. Goodenough CJ, Liang MK, Nguyen MT, et al. Preoperative glycosylated hemoglobin and postoperative glucose to- gether predict major complications after abdominal sur- gery. J Am Coll Surg. 2015;221(4):854-861.e1. doi:10.1016/j. jamcollsurg.2015.07.013 · DOI
  43. Jupiter DC, Humphers JM, Shibuya N. Trends in postoperative infection rates and their relationship to glycosylated hemo- globin levels in diabetic patients undergoing foot and ankle surgery. J Foot Ankle Surg. 2014;53(3):307-311. doi:10.1053/j. jfas.2013.10.003 · DOI

Cited by

Sorted by citations

Authors
Yu, A., Truong, Q., Whitfield, K., Hale, A., Taing, M., Barker, N., & D’Emden, M.
Affiliations
  • The University of Queensland (AU)
  • Cairns Hospital (AU)
  • Queensland University of Technology (AU)
  • School of Medicine The University of Queensland Herston Queensland Australia
Corresponding author
Yu, Abby
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2024-06-10
Volume
41
Issue
10
Pages
e15380-e15380
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.15380
OpenAlex
W4399500955
Cited by
13
References
2
Citations by year
2026: 5 · 2025: 8
FWCI
1.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetic Medicine (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
University of Queensland
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords
major noncardiac surgery, postoperative complications, diabetes mellitus, postoperative acute kidney injury, anastomotic leakage, surgical site infection, length of hospital stay, 30-day mortality, reoperation, perioperative cardiovascular events, hospital readmission, postoperative pneumonia, systemic thromboembolism
MeSH terms
Adult, Glycated Hemoglobin, Humans, Length of Stay, Postoperative Complications, Surgical Procedures, Operative, Preoperative Period, Observational Studies as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review