Association Between Hemoglobin A1c and Midurethral Sling Complications in Diabetic Women: A Cohort Study. Issue 3 (11th March 2021)

• Record Type: Journal Article
• Authors: Ortega, Marcus V.; Bangura, Marie; Ayati, Elnaz; James, Kaitlyn; Mitchell, Caroline; Weinstein, Milena M.; Von Bargen, Emily
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 27:Issue 3(2021)
• Page Start: 159
• Page End: 162
• Publication Date: 2021-03-11
• Subjects: stress incontinence -- diabetes -- sling failure -- midurethral sling -- sling complications; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000001003
• Languages: English
• ISSNs: 2151-8378

Abstract

Abstract : Objective: We aimed to evaluate the association between hemoglobin A1 c (HbA1 c ) levels and midurethral sling (MUS) complications. Methods: This was a multihospital, retrospective cohort study from 2010 to 2020. We included all women with diabetes mellitus who underwent a synthetic mesh MUS procedure and had a preoperative HbA1 c within 3 months of surgery. The primary outcome was a composite of complications, including MUS mesh exposure, surgical site granulation tissue or infection, urinary tract infection, surgical site pain beyond 6 weeks postoperatively, and MUS failure. A sensitivity analysis analyzing MUS failure alone was performed. Results: During the study period, 109 women met the inclusion criteria. Most were White (52.2%) and had a median body mass index of 31.2 kg/m 2, and 84.9% were postmenopausal. Median HbA1 c was 7.2% (interquartile range, 6.3%–7.7%). Urinary tract infection was the most common complication in 12 (11.0%) women. Mesh exposure was diagnosed in 7 (6.4%) women. Seventeen (15.6%) had MUS failure. On univariate regression analysis, a higher HbA1 c was associated with increased odds of composite complications (odds ratio, 1.67; 95% confidence interval, 1.20–2.32; P = 0.002) and MUS failure (odds ratio, 1.81, 95% confidence interval, 1.26–2.60; P = 0.001). On multivariate analysis, higher HbA1 c levels were associated with a composite of complications and failure ( P < 0.05). Based on the receiver operating characteristic curve, HbA1 c greater than 8% demonstrated a specificity of 85.7% and a sensitivity of 50% for MUS failure. Conclusions: In diabetic patients, a higher HbA1c was associated with a higher risk of MUS complications and failure. Obtaining an HbA1 c within 3 months of surgery may help with risk stratification.