Hb1c May Be Wrong for Surgical Risk in Diabetic Patients

HbA1c is widely used as a gatekeeping tool to delay or deny elective surgery in diabetic patients. Two new studies suggest it may be a poor indicator of actual surgical outcomes.

Study 1: Cervical spine surgery (ACDF)

In a study of 75 diabetic and prediabetic patients, HbA1c category had no significant impact on complication or revision rates at 30, 90, or 180 days postoperatively.

Study 2: Foot and ankle surgery (the more striking finding)

A second study examined 106 diabetic patients undergoing foot and ankle surgery:

• 87 achieved union; 19 developed nonunion.

• HbA1c at any level, including >8%, was not associated with nonunion.

• What predicted nonunion were higher BMI and lower vitamin D levels.

Traditional risk factors like smoking, neuropathy, and vascular disease showed no significant association.

Rethinking preoperative optimization

Across both spine and foot/ankle surgery, HbA1c alone appears to be a weak filter for surgical risk. BMI and vitamin D may be more actionable targets for optimizing diabetic patients before surgery.