Risk assessment

HbA1c

Also known as: glycated haemoglobin, A1c, HbA1c test

HbA1c is glycated haemoglobin, reflecting average blood glucose over roughly the preceding three months. It matters before surgery because poor glycaemic control is associated with higher rates of post-operative complications, particularly infection and impaired wound healing. Unlike a one-off glucose reading it cannot be improved quickly, so it has to be identified with weeks to spare.

Measures
Average blood glucose over roughly the preceding three months
Perioperative concern
Higher rates of post-operative infection and impaired wound healing
Modifiable
Yes, but slowly — requires weeks to months, not days
Common gap
Last confirmed result is months old, or only patient-reported

Why the timescale matters more than the number

HbA1c is the one common pre-operative finding where the value of discovering it early is unambiguous. A single high glucose on the morning of surgery is a snapshot; an HbA1c reflects months, and moving it takes months.

That makes it the clearest illustration of the general point about pre-operative timing. Identified at booking, poor control is an optimisation window — a referral back to the GP or diabetes service with weeks in hand. Identified at the pre-admission clinic three days before surgery, the same finding is either a cancellation or a case that proceeds at avoidable risk.

The two failure modes

The result is stale. A patient with diabetes may have an HbA1c on file, but from eight months ago, before a change in circumstances or medication.

The result is patient-reported. “Around nine” is a genuinely useful signal and a poor basis for a plan. It should be treated as a prompt to obtain a current result, not as one.

Pathways handles this by listing what it does not know. An HbA1c that is patient-reported or out of date appears explicitly under missing information on the risk profile, with the confidence attached — the staged example shows a patient-reported value at 0.86 confidence with “gap: recent HbA1c” recorded alongside it, and nineteen days of optimisation window still available.

Related terms

SGLT2 inhibitors (perioperative)

SGLT2 inhibitors such as empagliflozin and dapagliflozin must be withheld before surgery because they can cause euglycaemic diabetic ketoacidosis, in which ketoacidosis develops with normal or near-normal blood glucose. Because withholding must begin days before the procedure, the plan has to be made at booking rather than on admission.

Day-of-surgery cancellation

A day-of-surgery cancellation is a planned operation called off on the day it was scheduled, usually after the patient has arrived fasted. Most are preventable: the common causes are unmanaged medications, unoptimised comorbidity, unscreened risk such as sleep apnoea, and logistical failures — all of which are identifiable weeks earlier.

Pre-admission clinic

A pre-admission clinic assesses patients before elective surgery to identify and optimise anaesthetic risk. Its persistent problem is allocation rather than capability — clinics are commonly booked out for weeks with low-risk patients while high-risk patients receive a phone call, because slots are filled in booking order rather than by screened risk.

See how Pathways screens for this.

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