2925-LB: Preoperative HbA1c and Complications after Excision in Hidradenitis Suppurativa

Introduction and Objective: Hidradenitis suppurativa (HS) is frequently comorbid with dysglycemia and diabetes, but the association between preoperative glycemic control and postoperative complications after HS excision is not well defined. This study assessed whether elevated preoperative hemoglobin A1c (HbA1c) is associated with increased postoperative complications after HS-related surgery and sought to identify an HbA1c threshold that best stratifies risk. Methods: Using TriNetX (Johns Hopkins Medicine), patients who underwent HS-related incision and drainage or excision from 2005-2025 were identified based on their most recent HbA1c obtained within 3 months preoperatively. Exposure was defined using preoperative HbA1c thresholds ranging from 5.6% to 8.5%. At each HbA1c threshold (5.6%, 6.0%, 6.5%, 7.0%, 7.5%, 8.0%, and 8.5%), two cohorts were created. For example, at an HbA1c threshold of 5.6%, Cohort 1 included patients with HbA1c ≤5.6% and Cohort 2 included patients with HbA1c >5.6%. Cohorts were propensity score-matched 1:1 on age, sex, and race/ethnicity. The primary outcome was a 180-day composite of postoperative complications (wound disruption, infection, hemorrhage, seroma/hematoma, ulceration, acute pain, and sepsis). Results: Higher HbA1c was associated with greater complication risk at thresholds from 5.6% through 8.0% (all p ≤ .02). The strongest discrimination occurred at HbA1c 6.5%: 11.3% (150/1330) for HbA1c >6.5% vs 5.5% (70/1280) for HbA1c ≤6.5% (risk difference, 5.8 percentage points; OR, 2.2 [95% CI, 1.6-3.0]; p < .001). The association was not significant at the 8.5% threshold (p = .10). Conclusion: Elevated preoperative HbA1c was associated with increased 180-day postoperative complications after HS-related surgery, with maximal risk separation at 6.5%. These findings support preoperative glycemic optimization for HS surgery toward a target HbA1c ≤6.5%, with values above this level prompting enhanced perioperative risk assessment, optimization efforts, and closer postoperative surveillance. Disclosure K. Piri: None. K. Abraham-Aggarwal: None.