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Risk Stratification for Patients with Diabetes Undergoing Elective Soft Tissue Hand Procedures
Maria A Pagane, BA, MS
1, Justin A Ly, MD
2, Nicholas J Allen, BS, MEng
1, Raj Patel, MD
2, Lasya Sethi, MD
2, Andrew Lowery, MD
2; Mark Solarz, MD
2(1)Temple University Lewis Katz School of Medicine, Philadelphia, PA, (2)Temple University Hospital, Philadelphia, PA
IntroductionDiabetes mellitus affects a significant portion of the U.S. population and is associated with increased risk for upper extremity soft tissue pathologies.
1-5 Elective surgical intervention can often be delayed in patients with poor glycemic control due to concerns regarding wound healing and infection.
6-9 Although hemoglobin A1c (HbA1c) is commonly used to predict postoperative risk, no consensus exists on a threshold that reliably predicts complications.
7-11 Additionally, prior studies have largely focused on complications following open carpal tunnel release, with limited data evaluating elective soft tissue hand procedures more broadly.
7-11 This study seeks to evaluate if there is an association between perioperative HbA1c levels and wound complications following hand soft tissue procedures.
Materials & MethodsA retrospective chart review of patients who underwent elective soft tissue hand procedures between August 2016 and February 2024 at two urban academic centers was performed. Procedures included carpal tunnel release, cubital tunnel release, Guyon canal release, soft tissue mass excision, trigger finger release, first dorsal compartment release, lateral/medial epicondylectomy, palmar fasciectomy, and extensor carpi ulnaris tenolysis. Patients with HbA1c levels within three months of surgery and at least six weeks of follow-up were included and stratified into three groups: <7%, 7-8.9%, and ?9%. The primary outcome was wound complications defined as wound breakdown, infection requiring antibiotics, or need for incision and drainage. Additional outcomes included follow-up duration and revision surgery.
ResultsA total of 356 patients were included. Stratification by HbA1c yielded <7% (n=202), 7-8.9% (n=107), and ?9% (n=47). The overall complication rate was 3.4%, with no significant difference among groups (p=0.88). Mean HbA1c levels did not differ significantly between patients with complications and those without (7.37 vs 7.14, p=0.61). Higher HbA1c levels were associated with increased follow-up duration (mean follow-up 25.99 weeks for HbA1c ?9% vs 16.65 weeks for <7%, p=0.003). Need for revision surgery was rare (1.4%) and not significantly associated with HbA1c (p=0.84).
ConclusionsThis study found no significant difference in wound healing outcomes across HbA1c strata, and overall complication rates were low. Rigid HbA1c cutoffs may unnecessarily delay care, especially for underserved populations who bear a disproportionate burden of diabetes. More nuanced, patient-centered guidelines are needed, as associations between HbA1c and complications are not fully elucidated.
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