Elevated HbA1c is not associated with reoperation following arthroscopic rotator cuff repair in patients with diabetes mellitus

Abstract

Hyperglycemia is a known risk factor for tendon degeneration due to oxidative stresses from production of advanced glycosylation end products. In patients with Diabetes Mellitus (DM), analysis of glycated hemoglobin (HgA1c) provides a 3-month window into a patient's glucose control. No guidelines exist for ideal preoperative HgA1c and glucose control prior to arthroscopic rotator cuff repair. This study evaluated if a critical HgA1c level is associated with reoperation following arthroscopic rotator cuff repair. We retrospectively evaluated patients with DM who underwent primary arthroscopic rotator cuff repair from January 2014 to December 2018 at a single institution. Patients required a preoperative Hg1Ac within 3 months of surgery. Medical records were queried to evaluate for reoperation and identify the subsequent procedures performed. Univariate statistical analysis was performed to assess factors associated with reoperation (p< 0.05 considered significant). Threshold, area under the curve (AUC), analysis was performed to assess if a critical HgA1c value was associated with reoperation. 402 patients met inclusion criteria. Patients had an average age of 65.5 years (range 40-89) at time of surgery; 244 (60.6%) patients were male; and average BMI was 32.96 +/- 5.81. Mean HgA1c was 7.36 (Range 5.2 to 12). Thirty-three patients (8.2%) underwent subsequent reoperation. Six patients (1.5%) underwent capsular release and lysis of adhesions, 20 (5.0%) patients underwent a revision rotator cuff surgery, combination revision rotator cuff repair and lysis of adhesions, graft augmented revision repair, or superior capsular reconstruction, and 7 (1.7%) patients underwent revision to reverse shoulder arthroplasty (1.7%). There were no cases of reoperation for infection. On AUC analysis, no critical HgA1c value was identified to predispose to reoperation. Interestingly, elevated preoperative ASA (2.8 vs 2.28, p = 0.001) was associated with a higher reoperation rate. In patients with DM, preoperative HgA1c is not a predictive factor for surgical failure requiring reoperation. Stable glycemic control is important to a patient's overall health and may play a role in minimizing postoperative medical complications, but an elevated preoperative HgA1c should not be a strict surgical contraindication for arthroscopic rotator cuff repair. In patients with DM, an elevated ASA score is associated with an increased rate of subsequent reoperation; diabetic patients should be counselled accordingly.