Surgical Outcomes in Urogynecology-Assessment of Perioperative and Postoperative Complications Relative to Preoperative Hemoglobin A_1c-A Fellows Pelvic Research Network Study

Objectives: Poor control of diabetes mellitus is a known predictor of perioperative and postoperative complications. No literature to date has established a hemoglobin A_1c (HbA_1c) cutoff for risk stratification in the urogynecology population. We sought to identify an HbA_1c threshold predictive of increased risk for perioperative and postoperative complications after pelvic reconstructive surgery. Methods: This multicenter retrospective cohort study involving 10 geographically diverse U.S. female pelvic medicine and reconstructive surgery programs identified women with diabetes who underwent prolapse and/or stress urinary incontinence surgery from September 1, 2013, to August 31, 2018. We collected information on demographics, preoperative HbA_1c levels, surgery type, complications, and outcomes. Sensitivity analyses identified thresholds of complications stratified by HbA_1c. Multivariate logistic regression further evaluated the association between HbA_1c and complications after adjustments. Results: Eight hundred seven charts were identified. In this diabetic cohort, the rate of overall complications was 44.1%, and severe complications were 14.9%. Patients with an AM HbA_1c value of 8% or greater (reference HbA_1c, <8%) had an increased rate of both severe (27.1% vs 12.8%, P < 0.001) and overall complications (57.6% vs 41.8%, P = 0.002) that persisted after multivariate logistic regression (odds ratio, 2.618; 95% confidence interval, 1.560-4.393 and odds ratio, 1.931; 95% confidence interval, 1.264-2.949, respectively). Mesh complications occurred in 4.6% of sacrocolpopexies and 1.7% of slings. The average HbA_1c in those with mesh exposures was 7.5%. Conclusions: Preoperative HbA_1c of 8% or higher was associated with a 2-to 3-fold increased risk of overall and severe complications in diabetic patients undergoing pelvic reconstructive surgery that persisted after adjustments.