Effects of Screening Hemoglobin A1C on Complications in Implant-Based Breast Reconstruction.

Abstract

Background: Many institutions have implemented universal hemoglobin A1c (HbA1c) screening for all preoperative patients in an effort to reduce rates of surgical complications. However, the usefulness of HbA1c screening for predicting complications after implant-based breast reconstruction has yet to be determined. The purpose of this study was to investigate the predictive value of HbA1c screening on postoperative complications following implant-based breast reconstruction.

Methods: A retrospective cohort study of patients who underwent implant-based breast reconstruction at a single institution was conducted. All patients required an HbA1c screening preoperatively. Patients were categorized into 2 groups: normal HbA1c (<5.7%) or abnormal HbA1c (≥5.7%). The 2 groups were propensity score matched for baseline characteristics and compared for complication rates after the first- and second-stage procedures.

Results: In this study, 203 patients who underwent first-stage breast reconstruction were divided into normal HbA1c (n = 135) and abnormal HbA1c (n = 68) cohorts. A propensity score weighted analysis demonstrated increased risk of incisional dehiscence in the abnormal group (P = .050). Ninety-nine patients who underwent second-stage breast reconstruction were divided into normal HbA1c (n = 55) and abnormal HbA1c (n = 44) cohorts. The abnormal HbA1c group demonstrated marginally higher rates of implant loss (P = .059). Otherwise, no statistically significant differences were noted in rates of surgical site infection, seroma or hematoma formation, or implant rupture.

Conclusions: Patients with abnormal HbA1c on preoperative screening demonstrated higher rates of incisional dehiscence after first-stage breast reconstruction and higher rates of implant loss following second-stage breast reconstruction. Obtaining routine preoperative HbA1c screening should be considered as an adjunct to guide discussions about surgical risk for patients undergoing breast reconstruction.