Impact of Preoperative Hemoglobin A1c in Patients Undergoing Open Distal Vascular Procedures
Natour AK, Shepard A, Weaver M, Nypaver T, Henke P, and Kabbani L. Impact of Preoperative Hemoglobin A1c in Patients Undergoing Open Distal Vascular Procedures. J Vasc Surg 2022; 75(6):E224-E224.
J Vasc Surg
Objective: The objective was to evaluate if the preoperative hemoglobin (Hb)A1c level was associated with worse postoperative outcomes in patients undergoing open lower extremity (LE) revascularization.
Methods: A retrospective review of a statewide vascular surgery registry was queried for all patients who underwent open infrainguinal bypass or open LE thrombectomy procedures between January 2014 and June 2021. Patients were categorized into four groups depending on whether their plasma HbA1c was ≤6%, >6% to ≤8%, >8% to ≤10%, and >10%. Logistic regressions, Poisson models, and multiple linear regressions were used to evaluate the association between preoperative HbA1c and postoperative major adverse limb events (MALE, defined as above ankle amputation), major adverse cardiac events (MACE, defined as either clinically significant arrhythmia, myocardial infarction, congestive heart failure, or stroke), mortality, and length of stay (LOS).
Results: A total of 5388 patients were included in the study. The average age was 66 years. Sixty-six percent of the cohort were male, and 78% were White. Demographics (age and race) and comorbidities (obesity, smoking, diabetes, hypertension, congestive heart failure, hyperlipidemia, and a requirement for dialysis) were associated with the HbA1c level. On univariate analysis, LOS and perioperative MACE were significantly associated with the level of HbA1c. Mean LOS was 7 days for HbA1c <6% and 10 days for HbA1c >10% (P < .001). No significant association was found when looking at perioperative MALE (P = .96), 30-day mortality (P = .10), or 1-year mortality (P = .29). On multivariate analysis, only LOS remained significantly associated with the level of HbA1c (P < .001) (Table).
Conclusions: Suboptimal preoperative glycemic control in patients undergoing open LE vascular procedures for ischemia is associated with an increased risk of LOS. The HbA1c level was not predictive of worse perioperative MACE, MALE, or mortality in this cohort. The increase in LOS could be explained by unmeasured complications, frailty, or increased hospitalization time needed to optimize glycemic control before discharge. It is unclear if delaying surgery to improve HgA1c would improve outcomes based on this retrospective review.