{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:10:47Z","timestamp":1788667847672,"version":"build-2803163510"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Laparoendoscopic &amp; Advanced Surgical Techniques"],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Preoperative glycemic control is a key concern in bariatric surgery. However, the extent to which suboptimal HbA1c levels impact short-term postoperative morbidity remains uncertain. This study evaluated the association between preoperative HbA1c categories and 30-day postoperative morbidity in a large Middle Eastern bariatric surgery cohort, using propensity score weighting and unsupervised clustering to refine risk stratification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort analysis included 1778 bariatric surgery patients operated between 2019 and 2024 at a tertiary referral center in the United Arab Emirates. Patients were stratified into two groups: controlled HbA1c (\u22646.5%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 1557) and elevated HbA1c (&gt;6.5%,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 221). Baseline demographics, perioperative parameters, and 30-day outcomes were extracted from a prospectively maintained registry. Statistical analysis included inverse probability weighting using propensity scores to adjust for age, BMI, and sex. Principal component analysis (PCA) followed by K-means clustering was performed on age and HbA1c to identify multivariate patient subgroups. Both unweighted and weighted analyses were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Elevated HbA1c patients were older than those with controlled HbA1c (43.2 \u00b1 12.1 versus 34.6 \u00b1 10.8 years,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001 unweighted; 43.2 \u00b1 12.1 versus 42.1 \u00b1 12.0 years,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .364 weighted). BMI was modestly higher in the elevated group but not significant after weighting. Thirty-day complication rates were low across all groups. The highest risk was observed in patients &gt;60 years with diabetes (8.1%), while patients \u226420 years had negligible complications. In adults 21\u201360 years, complication rates increased modestly with HbA1c (normal 3.9%\u20135.3%, prediabetes 3.9%\u20136.3%, diabetes 6.5%\u20138.6%). No deaths occurred. Other complications, including deep\/organ-space SSI, pneumonia, pulmonary embolism, renal failure, myocardial infarction, transfusion, gastrointestinal bleeding, readmission, and reoperation, were rare and showed no significant differences across HbA1c strata (all\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Elevated HbA1c was not an independent predictor of short-term morbidity after bariatric surgery. PCA-cluster analysis identified a distinct high-risk subgroup: older diabetic patients, who demonstrated the greatest vulnerability to short-term complications. These findings suggest that perioperative risk assessment should move beyond HbA1c cutoffs alone and incorporate multivariate patient profiling to guide individualized care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10926429261486261","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T02:23:46Z","timestamp":1788402226000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond HbA1c: Multivariate Clustering and Propensity-Weighted Analysis Identify High-Risk Patients with Diabetes Undergoing Bariatric Surgery"],"prefix":"10.1177","author":[{"given":"Fathima Ruba","family":"Shamnad","sequence":"first","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan S.","family":"Barajas-Gamboa","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo D.","family":"Guerron","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Raza","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Pablo","family":"Pantoja","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Cruz","family":"Lopez Meyer","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safa Botros","family":"Hegazin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Salloum","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Abril","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-023-03165-3"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu15020363"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-062053"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0282502"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2005.07.010"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2021.109119"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1159\/000512428"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.77a.09135"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1200225"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f5934"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13679-020-00377-y"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-012-0693-1"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-017-2615-8"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-015-1603-0"},{"key":"e_1_3_2_16_1","unstructured":"15.Diabetes Research Institute Foundation. 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