Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

August 27, 2020, Update January 19, 2022.

Avoid elective abdominal surgery in the setting of adult patients with poorly controlled diabetes (hemoglobin A1c > 8%).

Poorly controlled type-2 diabetes in adults is associated with higher risk for infectious complications. Multiple studies have demonstrated association with hemoglobin A1c and infectious complications (HgA1c>7%), prolonged length of stay (HgA1c>8%), and mortality (HgA1c>9%) following surgery. Since diabetes control is often the primary indication for metabolic and bariatric surgery, it is reasonable and advisable to proceed with metabolic and bariatric surgery if the HgA1c remains >8% despite attempts at optimization.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


Dronge AS et al, 2006 Apr Long-term glycemic control and postoperative infectious Complications, JAMA, 141(4):375-80

Underwood P et al 2014, “PreOperative A&C and Clinical Outcomes in Patients with Diebates Undergoing Major Noncardiac Surgical Procedures,” Diabetes Care, 37: 611-616

Duggan EW et al 2017, “Perioperative Hyperglycemia Management: An Update,” Anesthesiology, 126 (3): 547-560.