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Hysterectomy Complications Relative to Hemoglobin A1c- Identifying a Threshold for Surgical Planning.

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Citation: Journal of Minimally Invasive Gynecology. 28(10):1735-1742.e1, 2021 10.PMID: 33617984Institution: MedStar Washington Hospital CenterDepartment: Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Hysterectomy | *Laparoscopy | Female | Humans | Hysterectomy/ae [Adverse Effects] | Postoperative Complications/di [Diagnosis] | Postoperative Complications/ep [Epidemiology] | Postoperative Complications/et [Etiology] | Reoperation | Retrospective Studies | Risk FactorsYear: 2021 ISSN:

1553-4650

Name of journal: Journal of minimally invasive gynecologyAbstract: CONCLUSION: Diabetes diagnosis and measurement of preoperative hemoglobin A1c provide risk stratification for postoperative complications after hysterectomy, with the highest observed effect among diabetics with a preoperative hemoglobin A1c >=9%. Copyright (c) 2021. Published by Elsevier Inc.DESIGN: Retrospective cohort study.INTERVENTIONS: Hysterectomy.MAIN RESULTS: We identified 41,286 hysterectomies performed at 70 hospitals included for analysis. The sensitivity analysis identified four groups of risk for postoperative complications- 1) no diabetes diagnosis and no hemoglobin A1c; 2) no diabetes diagnosis with hemoglobin A1c between 4 and 6.5%; 3) diabetes diagnosis and no hemoglobin A1c or hemoglobin A1c <9%; and 4) diabetes diagnosis with hemoglobin A1c >=9%. In the adjusted model, there was a significant 32% and 34% increased odds of postoperative complications for Groups 2 and 3, respectively, compared to Group 1. There was a more than two-fold increased odds of complications for women with diabetes and a preoperative hemoglobin A1c >=9% compared to Group 1. Diabetes diagnosis with preoperative hemoglobin A1c >=9% were at increased odds compared to diabetes diagnosis with preoperative hemoglobin A1c <9%. Well controlled diabetics appeared to have increased odds of complications with laparoscopic surgery.MEASUREMENTS: Data on demographics, preoperative hemoglobin A1c values, surgical approach, composite postoperative complications, readmissions, ER visits, and reoperations was abstracted. The risk of a postoperative complication when diabetes was stratified by preoperative hemoglobin A1c was evaluated in a sensitivity analysis and independent associations were identified in a mixed, multivariate logistic regression model.PATIENTS: Women with and without a diabetes diagnosis.SETTING: Hospitals in the Michigan Surgical Quality Collaborative between June 4, 2012 to October 17, 2017.STUDY OBJECTIVE: To evaluate whether diabetes diagnosis and level of diabetic control as reflected by higher preoperative hemoglobin A1c levels are associated with increased complication rates after hysterectomy, and to identify a threshold of preoperative hemoglobin A1c past which we should consider delaying surgery due to increased risk of complications.All authors: Gutman RE, Kamdar N, Morgan DM, Ringel NEOriginally published: Journal of Minimally Invasive Gynecology. 2021 Feb 19Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.jmig.2021.02.010

Date added to catalog: 2021-03-10

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Title notes ( 9 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	33617984	Available		33617984

CONCLUSION: Diabetes diagnosis and measurement of preoperative hemoglobin A1c provide risk stratification for postoperative complications after hysterectomy, with the highest observed effect among diabetics with a preoperative hemoglobin A1c >=9%. Copyright (c) 2021. Published by Elsevier Inc.

DESIGN: Retrospective cohort study.

INTERVENTIONS: Hysterectomy.

MAIN RESULTS: We identified 41,286 hysterectomies performed at 70 hospitals included for analysis. The sensitivity analysis identified four groups of risk for postoperative complications- 1) no diabetes diagnosis and no hemoglobin A1c; 2) no diabetes diagnosis with hemoglobin A1c between 4 and 6.5%; 3) diabetes diagnosis and no hemoglobin A1c or hemoglobin A1c <9%; and 4) diabetes diagnosis with hemoglobin A1c >=9%. In the adjusted model, there was a significant 32% and 34% increased odds of postoperative complications for Groups 2 and 3, respectively, compared to Group 1. There was a more than two-fold increased odds of complications for women with diabetes and a preoperative hemoglobin A1c >=9% compared to Group 1. Diabetes diagnosis with preoperative hemoglobin A1c >=9% were at increased odds compared to diabetes diagnosis with preoperative hemoglobin A1c <9%. Well controlled diabetics appeared to have increased odds of complications with laparoscopic surgery.

MEASUREMENTS: Data on demographics, preoperative hemoglobin A1c values, surgical approach, composite postoperative complications, readmissions, ER visits, and reoperations was abstracted. The risk of a postoperative complication when diabetes was stratified by preoperative hemoglobin A1c was evaluated in a sensitivity analysis and independent associations were identified in a mixed, multivariate logistic regression model.

PATIENTS: Women with and without a diabetes diagnosis.

SETTING: Hospitals in the Michigan Surgical Quality Collaborative between June 4, 2012 to October 17, 2017.

STUDY OBJECTIVE: To evaluate whether diabetes diagnosis and level of diabetic control as reflected by higher preoperative hemoglobin A1c levels are associated with increased complication rates after hysterectomy, and to identify a threshold of preoperative hemoglobin A1c past which we should consider delaying surgery due to increased risk of complications.

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