PMID- 32730894 OWN - NLM STAT- MEDLINE DCOM- 20211011 LR - 20221207 IS - 1097-6809 (Electronic) IS - 0741-5214 (Linking) VI - 73 IP - 4 DP - 2021 Apr TI - The impact of hemoglobin A(1c) on outcomes after lower extremity bypass. PG - 1332-1339.e5 LID - S0741-5214(20)31292-1 [pii] LID - 10.1016/j.jvs.2020.05.036 [doi] AB - OBJECTIVE: Diabetes has been shown to be associated with increased risk of postoperative complications after lower extremity bypass (LEB), although it is unclear whether medium-term glucose control affects outcomes. This study aimed to assess the association of perioperative hemoglobin A(1c) (HbA(1c)) level on perioperative outcomes after LEB. METHODS: We examined consecutive infrainguinal LEBs for chronic limb-threatening ischemia (CLTI) using the Vascular Quality Initiative database (2007-2018). Perioperative HbA(1c) levels were stratified into <5.7%, 5.7% to 6.5%, and >6.5%. Propensity score matching on demographics, medical history, and procedural characteristics was used to select comparable patients across HbA(1c) groups. The primary outcome was postoperative wound infection. Multivariable analyses were performed for matched and unmatched groups using Cox proportional hazards models for survival outcomes and logistic regression for binary outcomes with association expressed by adjusted hazard ratio (aHR) or adjusted odds ratio (aOR) and corresponding 95% confidence intervals (CIs). RESULTS: The CLTI cohort included 8171 infrainguinal LEBs: 631 (7.7%) had HbA(1c) <5.7%; 1691 (20.6%), 5.7% to 6.5%; and 5849 (71.6%), >6.5%. There was no difference in rates of wound infection in the CLTI cohort (HbA(1c) 6.5%, 3.2%; P = .53) or matched cohort (4.3%, 4.5%, 3.4%; P = .62). There were no differences in perioperative mortality in the CLTI cohort (2.5%, 1.7%, 1.5%; P = .16) or the matched cohort (2.7%, 2.3%, 2.2%; P = .84). In multivariable analysis, there was no significant association between HbA(1c) and wound infection in the CLTI cohort (HbA(1c) 5.7%-6.5% vs <5.7%: aOR, 0.91 [95% CI, 0.56-1.50; P = .72]; HbA(1c) >6.5% vs <5.7%: aOR, 0.81 [95% CI, 0.52-1.26; P = .35]). There was, however, a significant association between decreased HbA(1c) and mortality (HbA(1c) 5.7%-6.5% vs <5.7%: aHR, 0.77 [95% CI, 0.61-0.97; P = .03]; HbA(1c) >6.5% vs <5.7%: aHR, 0.75 [95% CI, 0.61-0.93; P = .01]). CONCLUSIONS: Our study suggests no significant association of increased HbA(1c) level and perioperative complications. Additional investigation is required to further evaluate the impact of short-term glycemic control and long-term outcomes of patients undergoing LEB. CI - Copyright (c) 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - Lee, Ashton AU - Lee A AD - Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz. FAU - Haddad, David AU - Haddad D AD - Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz. FAU - Rybin, Denis AU - Rybin D AD - Boston University School of Public Health, Boston, Mass. FAU - Howell, Caronae AU - Howell C AD - Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz. FAU - Ghaderi, Iman AU - Ghaderi I AD - Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz. FAU - Berman, Scott AU - Berman S AD - Pima Vascular Institute, Tucson, Ariz. FAU - Zhou, Wei AU - Zhou W AD - Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz. FAU - Tan, Tze-Woei AU - Tan TW AD - Division of Vascular Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Ariz. Electronic address: ttan@surgery.arizona.edu. LA - eng PT - Journal Article DEP - 20200728 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Biomarkers) RN - 0 (Glycated Hemoglobin A) RN - 0 (hemoglobin A1c protein, human) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Biomarkers/blood MH - Chronic Disease MH - Databases, Factual MH - Diabetes Mellitus/*blood/diagnosis/mortality MH - Female MH - Glycated Hemoglobin/*metabolism MH - Humans MH - Ischemia/diagnosis/mortality/*therapy MH - Lower Extremity/*blood supply MH - Male MH - Middle Aged MH - Peripheral Arterial Disease/diagnosis/mortality/*therapy MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Surgical Wound Infection/etiology/mortality MH - Time Factors MH - Treatment Outcome MH - *Vascular Grafting/adverse effects/mortality MH - Young Adult OTO - NOTNLM OT - Chronic limb threatening ischemia OT - Diabetes OT - Hemoglobin A1c OT - Lower extremity bypass EDAT- 2020/07/31 06:00 MHDA- 2021/10/12 06:00 CRDT- 2020/07/31 06:00 PHST- 2019/11/14 00:00 [received] PHST- 2020/05/14 00:00 [accepted] PHST- 2020/07/31 06:00 [pubmed] PHST- 2021/10/12 06:00 [medline] PHST- 2020/07/31 06:00 [entrez] AID - S0741-5214(20)31292-1 [pii] AID - 10.1016/j.jvs.2020.05.036 [doi] PST - ppublish SO - J Vasc Surg. 2021 Apr;73(4):1332-1339.e5. doi: 10.1016/j.jvs.2020.05.036. Epub 2020 Jul 28.