Association Between Preoperative HbA1c Levels and Complications after Esophagectomy Analysis of 15,801 Esophagectomies From the National Clinical Database in Japan

Objective: To elucidate the association between preoperative hemoglobin A1c (HbAlc) levels and short-term outcomes after oncologic esophagectomy. Summary Background Data: Although diabetes mellitus is associated with an increased risk of postoperative morbidity in several types of surgery, the association of diabetes mellitus with short-term outcomes after esophagectomy has shown conflicting results. Methods: We analyzed 15,801 patients who underwent oncologic esophagectomy between 2015 and 2017 from the National Clinical Database. We evaluated the associations between preoperative HbA1c levels and short-term outcomes, using multivariable logistic regression and restricted cubic spline models. Results: The cohort included 12,074, 1361, 1097, 909, and 360 patients with HbA1c levels of <= 5.9%, 6.0% to 6.4%, 6.5% to 6.9%, 7.0% to 7.9%, and >= 8.0%, respectively. There were value-dependent associations between HbA1c values and odds ratios for anastomotic leakage, surgical site infections, pneumonia, and composite outcomes. Compared with the HbA1c category of <= 5.9%, the categories of 7.0% to 7.9% and >= 8.0% were at higher risk for anastomotic leakage (P < 0.001 and 0.031, respectively), the category of >= 8.0% was at higher risk for surgical site infections (P = 0.001), the categories of 6.5% to 6.9% and 7.0% to 7.9% were at higher risk for pneumonia (P = 0.016 and 0.002, respectively), and the categories of 7.0 to 7.9 and > 8.0% were at higher risk for composite outcomes (P < 0.001 and 0.001, respectively). Conclusions: Preoperative HbA1c levels are associated with the risk of postoperative complications after esophagectomy, and the threshold values differed among the outcomes. Preoperative HbA1c is useful in predicting the risk of postoperative complications.