IFT01. Preoperative Hemoglobin A1c Level as an Independent Predictor of Perioperative Complications After Revascularization in Diabetic and Nondiabetic Critical Limb Ischemia Patients

Abstract

Hemoglobin A1c (HbA1c) reflects average blood glucose over a 2- to 3-month period. Patients with an elevated HbA1c with and without diabetes have an increased risk of adverse outcome following surgical intervention. The objective of this study was to determine the correlation between preoperative plasma HbA1c level and perioperative major adverse cardiac events (MACE), major adverse limb events (MALE), and mortality. This is a single-center, retrospective, observational study included 307 patients with critical limb ischemia who underwent revascularization from January 2017 to Jan 2018. Patients were categorized into two groups as either diabetic or nondiabetic (n = 54) based on their history and preoperative plasma HbA1c level of 6.5% or greater or less than 6.5%, respectively. Diabetics (n = 253) were divided into four groups: HbA1c less than 6.5% (7.90%), HbA1c of 6.5 or greater to 7.4% (23.72%), HbA1c of 7.5 to 8.9% (45.45%), HbA1c of 9 or greater (22.93%). Nondiabetics (n = 54) were put into two groups: HbA1c of less than 6.0 (42.59%) and HbA1c of 6 or greater to 6.5% (57.41%). Preoperative HbA1c, baseline data (age/sex), and perioperative MACE, MALE, and death were collected from our institute records. A total of 307 patients were studied, of which 253 were diabetics and 54 were nondiabetics. Patients with diabetes with HbA1c of greater than 9% had a significantly higher incidence of perioperative MACE (12.07% vs 2.05%; P = .0169), MALE (5.17% vs 1.53%; P = .0416), and death (10.34% vs 1.02%; P = .0047) compared with patients with an HbA1c of less than 9 (Fig). Patients without diabetes with HbA1c levels of 6.0% to 6.5% had a higher incidence of perioperative MACE, MALE and death compared with patients with HbA1c of less than 6%, but this observed difference is not statistically significant (P > .05). Postrevascularization critical limb ischemia in patients with an HbA1c of less than 9% carries the highest risk of perioperative complications and HbA1c levels serves as an independent predictor of these untoward events.