Effect of Hemoglobin A1c on Union Rates in Foot and Ankle Surgery
Madison Burandt1, Matthew Blaszczyk1, Michael Savisky2
1Resident, Division of Foot and Ankle Surgery, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, United States.
Summary
Hemoglobin A1c levels do not predict bone healing after foot and ankle surgery in diabetic patients. Instead, higher body mass index and lower vitamin D levels are linked to impaired healing, suggesting they are more critical risk factors.
Area of Science:
- Orthopedic Surgery
- Endocrinology
- Metabolic Disorders
Background:
- Diabetes Mellitus is linked to poor bone healing after foot and ankle surgery.
- Hemoglobin A1c (HbA1c) is a common surgical risk assessment tool, but its impact on postoperative union is not well-understood.
Purpose of the Study:
- To investigate the association between preoperative hemoglobin A1c levels and bone union rates in diabetic patients undergoing foot and ankle surgery.
- To identify potential predictors of impaired osseous healing in this patient population.
Main Methods:
- Retrospective review of 106 diabetic patients who had foot and ankle surgery between January 2015 and May 2020.
- Collected demographic and clinical data, including HbA1c, BMI, smoking, neuropathy, vitamin D, CKD, and PVD.
- Categorized patients based on osseous healing status (union vs. nonunion).
Main Results:
- No association was found between preoperative HbA1c, last recorded HbA1c, or HbA1c categories (<7%, 7-8%, >8%) and nonunion.
- Age, sex, surgical site, smoking, neuropathy, PVD, and CKD did not significantly impact healing.
- Patients with nonunion had higher body weight, BMI, and lower vitamin D levels compared to those who achieved union.
Conclusions:
- Preoperative hemoglobin A1c is not associated with postoperative bone healing in diabetic patients undergoing foot and ankle surgery.
- Elevated body mass index and low vitamin D levels are associated with impaired healing and may be more significant modifiable risk factors than HbA1c.
