D64. Reevaluating Hemoglobin A1c and Other Factors as Preoperative Risk Stratifiers of Autologous and Alloplastic Breast Reconstruction: A Receiver Operative Characteristic Curve Analysis of National NSQIP Data

PURPOSE: Hemoglobin A1c (HbA1c) is often assessed during preoperative planning. Although a HbA1c of 7.0 is frequently considered the cutoff, there is a paucity of literature supporting this. We aimed to evaluate the effectiveness of HbA1c in predicting complications and the utility of a 7.0 cutoff for breast reconstruction patients. Secondarily, we aimed to identify additional useful risk factors for plastic surgeons. METHODS: Retrospective analysis was conducted utilizing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Database (2020-2021). Complications were categorized into groups: A) wound dehiscence; B) surgical site infection (SSI); and C) all complications available. Multivariable logistic regressions were performed to examine the association of HbA1c, age, body mass index (BMI), diabetes status, smoking status, and hypertension status with complications. Receiver operating characteristic (ROC) curves were constructed to assess the discriminatory ability of significant predictors and HbA1c for complications. RESULTS: The study population included 1,305 cases. BMI was the only significant predictor for Group C. Patients with BMIs greater than 35 kg/m2 had the highest odds of complications (OR 2.39, p=0.003). From the ROC curves, the average HbA1c cutoff level across all groups was 6.9. The average area under the curve (AUC) across all groups for HbA1c was 0.526. When BMI was evaluated, the average cutoff was 28.4 kg/m2, and the average AUC was 0.626. CONCLUSION: HbA1c had limited utility predicting complications for breast reconstruction patients; BMI was more effective. Plastic surgeons should carefully consider what patient variables they prioritize when predicting surgical complication risk.