The Impact of Peri-operative HbA 1c on Complication Rates Following Foot and Ankle Surgery: A Systematic Review
Jacek Edward Parylo, Erika Pond, Basil Budair, Paula McQuailBackground:
Daibetes Mellitus (DM) is one of the most prevalent chronic conditions worldwide, and orthopaedic patients with poorly controlled DM often have poorer functional outcomes and increased complication rates. It is crucial to understand how to identify and mitigate as much risk as is feasible in this population when considering foot and ankle surgery. Foot and ankle surgery is particularly fraught with difficulty given the predilection diabetes has for the foot in the development of pathologies and complications.
Methods:
PubMed, Embase, MEDLINE, Ovid, Cochrane Library, and Trip medical databases were searched to identify studies concerning postoperative complications and their relationship to pre-operative HbA 1c measurements following foot and ankle surgeries. Patient characteristic data; HbA 1c data; and post-operative complication data was collected. Surgeries for amputations and existing infections were excluded.
Results:
A total of 2506 articles were highlighted on literature search. Twenty-nine full-text articles were accessible and read for inclusion. Of these, thirteen full-text articles were included in the review. Six studies showed a correlation between elevated HbA 1c and surgical site infection development; three studies found no significant link. No clear overall correlation could be found between higher HbA 1c and bone healing complications. Data suggested that peripheral neuropathy (PN) and peripheral vascular disease (PVD) may be correlated to development of complications .
Conclusion:
No clear HbA 1c threshold could be identified as an evidence-based cut-off value. Data from included studies suggested a relationship between elevated HbA 1c and surgical site infection development, although because of data heterogeneity these results are hypothesis-generating only and require more standardised reporting for analysis. Conclusions could not be drawn for bone healing complications. The presence of PVD and PN emerged as potentially stronger predictors than HbA 1c in a small number of studies; this hypothesis-generating observation requires further investigation to assess its true impact on development of complications and poor post-operative outcomes.