Perioperative care, nutrition & critical care: a free FRCS (Gen Surg) Section 1 question

The principle is that poor preoperative glycaemic control predicts surgical site infection, anastomotic and wound failure, longer stay and death, and that it is modifiable before elective surgery. UK guidance from the Centre for Perioperative Care and the Joint British Diabetes Societies advises that an HbA1c of 69 mmol/mol (8.5%) or more should prompt referral for optimisation and deferral of elective surgery where it is safe to wait. A value of 48 mmol/mol is the diagnostic threshold for diabetes and 58 mmol/mol a common treatment-intensification target, so both are too strict; 86 and 100 mmol/mol would allow operating with clearly poor control. Reference: Centre for Perioperative Care, Guideline for Perioperative Care for People with Diabetes Mellitus Undergoing Elective and Emergency Surgery (2021).