Glycated hemoglobin and postoperative complications in plastic surgery: a retrospective cohort study

Background: While glycemic control is a recognized determinant of surgical outcomes, its role in plastic surgery remains underexplored. This study investigates the prevalence of dysglycemia and its association with complications after procedures conducted by plastic surgeons using a national dataset. Methods: This multi-institutional retrospective cohort study analyzed 14,629 procedures conducted by plastic surgeons from the 2021 to 2023 American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified into six groups based on diabetes diagnosis and hemoglobin A1c (HbA 1c ) levels. Multivariable logistic regression assessed associations between glycemic status and postoperative complications, controlling for comorbidities, demographics, and surgical factors. Subgroup analyses examined unadjusted procedure-specific risks across the ten most common surgeries. Results: About 7% of patients without a recorded diabetes diagnosis met laboratory thresholds for diabetes, highlighting a hidden burden of unrecognized metabolic dysfunction. Diagnosed diabetes was independently associated with higher odds of complications. Notably, even patients with normoglycemic HbA 1c (<5.7%) and a diabetes diagnosis showed elevated risks of any (aOR 1.4, P = 0.02) and medical complications (aOR 2.6, P < 0.001). Undiagnosed dysglycemia, however, was not linked to increased risk after adjustment. Complication rates varied by procedure type, with free flap reconstruction and mastopexy demonstrating a strong association between poor glycemic control and adverse outcomes. Conclusion: Dysglycemia is highly prevalent and significantly associated with adverse postoperative outcomes in plastic surgery. Even patients with “optimal” HbA 1c levels experienced elevated risks, suggesting that current HbA 1c thresholds may underestimate true perioperative vulnerability. Investigations into the utility of preoperative HbA 1c screening and treatment should be considered.