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 (HbA1c) levels and short-term outcomes after oncologic esophagectomy. SUMMARY BACKGROUND DATA:Although diabetes mellitus (DM) is associated with an increased risk of postoperative morbidity in several types of surgery, the association of DM with short-term outcomes after esophagectomy has shown conflicting results. METHODS:We analyzed 15801 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 12074, 1361, 1097, 909, and 360 patients with HbA1c levels of ≤5.9%, 6.0%–6.4%, 6.5%–6.9%, 7.0%–7.9%, and ≥8.0%, respectively. There were value-dependent associations between HbA1c values and odds ratios (ORs) for anastomotic leakage (AL), surgical site infections (SSIs), pneumonia, and composite outcomes. Compared with the HbA1c category of ≤5.9%, the categories of 7.0%–7.9% and ≥8.0% were at higher risk for AL (P