Background

Metabolic/bariatric surgery (MBS) is well-established for treating obesity and its complications; however, outcomes depend on careful patient selection. Though relationships between preoperative HbA1c levels and MBS outcomes remain unclear, HbA1c values may affect surgical decision-making. As patients may be first diagnosed with prediabetes/diabetes as they pursue MBS, we sought to quantify patterns of preoperative HbA1c availability among patients who underwent MBS procedures.Materials and

Methods

We identified patients who underwent primary laparoscopic sleeve gastrectomy or laparoscopic/open Roux-en-Y gastric bypass from 2017 through 2021 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Demographic and clinical characteristics of patients with vs. without preoperative HbA1c values were compared using descriptive methods.

Results

A total of 802,205 patients met criteria. Overall mean patient age was 43.9 years (SD=11.9); 63.5% of patients were White, 20.5% were Black, and 15.1% were Hispanic; however, neither age nor race were differentially associated with the presence of preoperative HbA1c values. The proportion of patients with HbA1c data was 35.6 % in 2017, 38.5% in 2018, 39.9% in 2019, 48.4% in 2020, and 53.4% in 2021. Across the study period, 54.2% of patients with medically-treated diabetes had reported HbA1c levels vs. 39.6% without.

Conclusions

The proportion of patients with preoperative HbA1c increased by 50% from 2017-2021; however, in 2021, HbA1c values remained missing for 46.6% of patients. Given the importance of preoperative optimization, further research is warranted to determine if preoperative measurement of HbA1c levels should become standard of care for MBS patients.