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S-144 lack of association between glycated hemoglobin and adverse outcomes in diabetic patients undergoing ventral hernia repair: an ACHQC study

  • 2022 SAGES Oral
  • Published:
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Abstract

Introduction

Elevated preoperative glycated hemoglobin (HbA1c) is believed to predict complications in diabetic patients undergoing ventral hernia repair (VHR). Our objective was to assess the association between HbA1c and outcomes of VHR in diabetic patients.

Methods

We conducted a retrospective cohort study using the Abdominal Core Health Quality Collaborative (ACHQC) database. We included adult diabetic patients who underwent elective VHR with an available HbA1c result. The patients were divided into two groups (HbA1c < 8% and HbA1c ≥ 8%). Patient demographics, comorbidities, hernia characteristics, operative details, and surgical outcomes were compared. Multivariable logistic regression analysis of complications was performed. Cox proportional hazard regression was used to assess probability of composite recurrence at different HbA1c levels.

Results

2167 patients met the inclusion criteria (HbA1c < 8% = 1,776 and HbA1c ≥ 8% = 391). Median age was 61 years and median body mass index was 34 kg/m2. 75% had an American Society of Anesthesiology class of 3. The median HbA1c was 6.5% in the HbA1c < 8% group versus 8.7% in the HbA1c ≥ 8% group. 73% were incisional hernias, 34% were recurrent, and median hernia width was 6 cm. Open approach was used in 63% and myofascial release was performed in 46%. Median follow-up was 27 days. There were no clinically significant differences in the rates of overall 30-day complications, wound complications, reoperation, readmission, mortality, length of stay and quality of life and pain scores between the two groups. Regression analyses did not identify an association between HbA1c and the rates of complications, surgical site infection or composite recurrence across the spectrum of HbA1c values.

Conclusion

Our study finds no evidence of an association between HbA1c and operative outcomes in diabetic patients undergoing elective VHR.

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Acknowledgements

The authors would like to thank Dan Neal of the University of Florida for his help in providing statistical review for the study protocol and Thomas Stewart of Vanderbilt University School of Medicine for his help in reviewing the statistical analysis.

Funding

Melanie Vargas received an award for this project as Medical Summer Research Scholarship from the University of Florida College of Medicine.

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Authors and Affiliations

  1. Department of Surgery, University of Florida College of Medicine, PO Box 100108, Gainesville, FL, 32610-0108, USA

    Mazen R. Al-Mansour & Thomas E. Read

  2. University of Florida College of Medicine, Gainesville, USA

    Melanie Vargas

  3. Department of Population Health Sciences, Weill Cornell Medical College, New York, USA

    Molly A. Olson

  4. University of Texas Southwestern, Austin, USA

    Anand Gupta

  5. Department of Anesthesia, University of Florida College of Medicine, Gainesville, USA

    Nelson N. Algarra

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  1. Mazen R. Al-Mansour
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Correspondence to Mazen R. Al-Mansour.

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Disclosures

Mazen R. Al-Mansour received speaker fees from Medtronic Inc., educational support from Intuitive Surgical and general payments from W. L. Gore & Associates, Inc. and ConMed Corporation. The ACHQC has contracted with Weill Cornell Medicine to provide biostatistical support for ACHQC projects. The work provided for this manuscript was performed under the umbrella of the Weill Cornell Medicine and ACHQC collaboration plan. Mazen R. Al‑Mansour, Melanie Vargas, Molly A. Olson, Anand Gupta, Thomas E. Read and Nelson N. Algarra have no conflicts of interest or financial ties to disclose.

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Al-Mansour, M.R., Vargas, M., Olson, M.A. et al. S-144 lack of association between glycated hemoglobin and adverse outcomes in diabetic patients undergoing ventral hernia repair: an ACHQC study. Surg Endosc 37, 3180–3190 (2023). https://doi.org/10.1007/s00464-022-09479-1

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