Hysterectomy Complications Relative to HbA1c Levels: Identifying a Threshold for Surgical Planning.
J Minim Invasive Gynecol
; 28(10): 1735-1742.e1, 2021 10.
Article
in En
| MEDLINE
| ID: mdl-33617984
ABSTRACT
STUDY OBJECTIVE:
To evaluate whether diabetes diagnosis and level of diabetes control as reflected by higher preoperative glycosylated hemoglobin (HbA1c) levels are associated with increased complication rates after hysterectomy and to identify a threshold of preoperative HbA1c level past which we should consider delaying surgery owing to increased risk of complications.DESIGN:
Retrospective cohort study.SETTING:
Hospitals in the Michigan Surgical Quality Collaborative between June 4, 2012, and October 17, 2017. PATIENTS Women with and without a diabetes diagnosis.INTERVENTIONS:
Hysterectomy. MEASUREMENTS AND MAINRESULTS:
Data on demographics, preoperative HbA1c values, surgical approach, composite postoperative complications, readmissions, emergency department visits, and reoperations were abstracted. The risk of a postoperative complication when diabetes was stratified by preoperative HbA1c level was evaluated in a sensitivity analysis, and independent associations were identified in a mixed, multivariate logistic regression model. We identified 41 286 hysterectomies performed at 70 hospitals to be included for analysis. The sensitivity analysis identified 4 groups of risk for postoperative complications group 1 no diabetes diagnosis and no HbA1c value; group 2 no diabetes diagnosis, with HbA1c levels between 4% and 6.5%; group 3 diabetes diagnosis and no HbA1c value or HbA1c levels <9%; and group 4 diabetes diagnosis with HbA1c levels ≥9%. In the adjusted model, there were significant 32% and 34% increased odds of postoperative complications for groups 2 and 3, respectively, compared with group 1. There were more than 2-fold increased odds of complications for women with diabetes and a preoperative HbA1c level ≥9% (group 4) compared with the women in group 1. Diabetes diagnosis with preoperative HbA1c levels ≥9% had increased odds of complications compared with diabetes diagnosis with preoperative HbA1c levels <9%. Patients with well-controlled diabetes seemed to have increased odds of complications with laparoscopic surgery.CONCLUSION:
Diabetes diagnosis and measurement of preoperative HbA1c levels provide risk stratification for postoperative complications after hysterectomy, with the highest observed effect among patients with diabetes with a preoperative HbA1c level ≥9%.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Laparoscopy
/
Hysterectomy
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
Language:
En
Journal:
J Minim Invasive Gynecol
Journal subject:
GINECOLOGIA
Year:
2021
Document type:
Article