The impact of preoperative optimization for abdominal wall reconstruction on long-term glucose control and smoking...

Poorly controlled diabetes mellitus (DM) and tobacco use are known risk factors for surgical complications, particularly poor wound healing and infection. Thus, preoperative optimization prior to elective abdominal wall reconstruction (AWR) to lower patients' glycated hemoglobin (HbA1c) and achieve smoking cessation improves surgical outcomes and patients' overall health. The impact of surgeons and surgery on long-term maintenance of preoptimization is not adequately described, so this study evaluated the sustainability of preoptimized HbA1c and smoking status after AWR.

A prospectively maintained hernia database was reviewed for diabetic patients with HbA1c > 7.2 and actively smoking patients preoptimized before open AWR. Patients' HbA1c improved ≤ 7.2 and smoking cessation achieved for ≥ 4 weeks preoperatively. HbA1c and smoking status were recorded at initial consultation, surgery, and most recent follow-up. Standard analyses were performed.

Of 51 optimized diabetic patients, HbA1c decreased from 8.5 ± 1.6 to 6.5 ± 0.6 after 10.6 ± 12.9 months of preoptimization (p < 0.001). HbA1c was 6.9 ± 1.5 (p < 0.001) at most recent follow-up, 43.0 ± 36.1 months postoperatively. Postoperatively, 63.2% of optimized patients maintained HbA1c ≤ 7.2; 95.8% of those continued to decrease their HbA1c after surgery. Of non-optimized patients, 22.2% improved their HbA1c ≤ 7.2 postoperatively. Average HbA1c was not different between optimized and non-optimized patients at initial consultation, but optimized patients had significantly lower HbA1c than non-optimized patients at most recent follow-up (6.9 ± 1.5 vs. 8.4 ± 1.7; p < 0.001). Seventy smoking patients at consultation achieved smoking cessation by surgery. With 28.1 ± 34.1 months follow-up, 58.6% continued to abstain from tobacco use. Of non-optimized patients, only 14.9% quit smoking postoperatively.

Diabetic and smoking patients were successfully preoptimized before elective AWR. Of patients meeting preoperative requirements for glucose control and smoking cessation, 63.2% maintained HbA1c ≤ 7.2 and 58.6% maintained smoking cessation with long-term follow-up postoperatively. The longevity of preoptimization demonstrates that surgeons can impact patients' long-term health well beyond AWR.