Hemoglobin A1c and Reoperation After Surgery for Stress Incontinence or Prolapse

Abstract

Importance Few studies compare the link between hemogobin A1c (HbA1c) and urogynecologic surgical complications. Objective The objective of this study was to determine the association between HbA1c and reoperation in women undergoing surgery for stress urinary incontinence (SUI) or pelvic organ prolapse (POP). Study Design We performed 2 separate retrospective cohort analyses using Cerner's HealthFacts Database (750 hospitals; 519,000,000 patient encounters from January 1, 2010, to November 30, 2018). We included women undergoing surgery for (1) SUI or (2) apical POP by International Classification of Diseases coding who had HbA1c at the initial procedure. Each analysis compared those undergoing reoperation for complications or recurrence and those who did not. Multivariable logistic regression assessed the association between reoperation and HbA1c both as a continuous variable and comparing the commonly accepted cutoff ≥8. Results Of 30,180 SUI surgical procedures and 26,389 POP surgical procedures, 1,625 (5.4%) and 805 (3.1%) had HbA1c. Median (interquartile range) HbA1c in grams per deciliter was similar by reoperation status (SUI: 6.0 [5.6–6.8] vs 6.1 [5.6–6.9], P = 0.35; POP: 6.2 [5.6–6.6] vs 6.1 [5.7–6.8], P = 0.60). Reoperation was also similar using the HbA1c ≥8% cutoff (SUI: 6.9% vs 7.4%, P = 0.79; POP: 6.3% vs 5.4%, P = 0.77). On multivariate analysis, HbA1c value was not a significant predictor of reoperation either as a continuous (SUI: odds ratio [OR] = 0.966, 95% CI = 0.833–1.119; POP: OR = 1.040, 95% CI = 0.801–1.350) or dichotomous variable ≥8 (SUI: OR = 0.767, 95% CI = 0.407–1.446; POP: OR = 0.988, 95% CI = 0.331–2.951). Mean follow-up was 4.28–5.13 years. Conclusion Although other studies have shown a link between diabetes and complications, we were unable to show an association between HbA1c values and rates of reoperation.