title: The impact of glycosylated hemoglobin and diabetes mellitus on wound-healing complications and infection after foot and ankle surgery.
abstract: BACKGROUND
  The relationship between hyperglycemia and adverse outcomes after surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate whether hemoglobin A1c (HbA1c) level was independently associated with postoperative complications in a retrospective cohort study.
  
  
  METHODS
  Three hundred twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative foot and ankle surgery complications.
  
  
  RESULTS
  Bivariate analyses showed that HbA1c level and having at least one comorbidity were associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c level, with each increment of 1% increasing the odds of infection by a factor of 1.59 (95% confidence interval [CI], 1.28-1.99). For postoperative wound-healing complications, bivariate analyses showed that body mass index, having at least one comorbidity, and HbA1c level were significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (odds ratio, 2.03; 95% CI, 1.22-3.37) and HbA1c level (each 1% increment) (odds ratio, 1.25; 95% CI, 1.02-1.53).
  
  
  CONCLUSIONS
  In this retrospective study, HbA1c level had the strongest association with postoperative foot and ankle surgery complications in patients with diabetes.
authors: Jon M
authors: JM
authors: Humphers
authors: Naohiro
authors: N
authors: Shibuya
authors: Benjamin L
authors: BL
authors: Fluhman
authors: Daniel
authors: D
authors: Jupiter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005528:Foot / Q000601:surgery*; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D014945:Wound Healing
chemical_list: D006442:Glycated Hemoglobin