Elevated Preoperative Hemoglobin A1c Associated with Increased Wound Complications in Diabetic Patients undergoing Primary, Open Carpal Tunnel Release.
PURPOSE: An increased rate of complications has been demonstrated with increasing hemoglobin A1c (HbA1c) for a variety of orthopaedic procedures, including arthroplasty and spine surgery. We investigated the effects of elevated HbA1c on postoperative complications at the time of carpal tunnel release (CTR). METHODS: This retrospective, cohort study evaluated all diabetic patients with a pre-operative HbA1c within 90 days of primary, open CTR at a single academic institution within the past 10 years. Binary HbA1c thresholds were tested for association with outcomes of superficial or deep infection, delayed wound healing, and persistent symptoms using Chi-square analysis. Multivariable models with adjustment for baseline and operative factors were then constructed. Odds ratios and 95% confidence intervals (CI) were displayed. RESULTS: HbA1c greater than or equal to 7.8 was most strongly associated with an increased risk of all-cause wound healing complications (p=0.049) at an odds ratio of 4.2 (95% CI 1.0 - 17.7) in adjusted analyses. Six patients (4%) experienced delayed wound healing and 5 patients (4%) developed a superficial infection. Six patients (4%) reported persistent carpal tunnel syndrome symptoms. CONCLUSIONS: Diabetic patients undergoing open, primary CTR with a HbA1c greater than or equal to 7.8 had a higher rate of post-operative wound complications compared to diabetic patients with improved pre-operative glucose control. Diabetics with poor glycemic control should be counseled that their risk of postoperative complication is higher. Further work is needed to determine if delaying surgery to optimize glucose control could result in a reduction of wound healing complications.
Cunningham, DJ; Baumgartner, RE; Federer, AE; Richard, MJ; Mithani, SK
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