Hysterectomy Complications Relative to Hemoglobin A1c- Identifying a Threshold for Surgical Planning.
- 2021
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.