Impact of Hemoglobin Glycation Index on Complications Following Orthopedic Surgery: A Retrospective Comparative Propensity Score‐Matched Study

OBJECTIVE: Patients with impaired glucose metabolism have an increased incidence of post-operative complications. The best marker for glycemic control prior to elective orthopedic surgery remains unclear. We aimed to assess the utility of the hemoglobin glycation index (HGI) in predicting early complications following elective orthopedic surgery. METHODS: We retrospectively enrolled 1496 patients who underwent elective orthopedic surgery at Fujian Provincial Hospital in China from Jan 2015 to Jan 2023. Restricted cubic spline (RCS) was used to select the cutoff value of HGI. Propensity score matching (PSM) was performed to reduce confounding bias, and multivariate logistic regression models (with and without adjustment) for complication outcomes were applied to evaluate the odds ratios of HGI. RESULTS: The U-shaped curve in RCS analysis suggested dividing HGI into three subgroups: the reference interval (-0.76 to -0.10), the lower group (≤ -0.76), and the higher group (> -0.10). The incidence of early complications significantly increased from the lower (12.5%) and higher (12.2%) subgroups to the reference interval (6.9%). Following PSM, total postoperative complications were more common in patients with lower HGI (OR: 3.272, 95% CI: 1.417-7.556), but patients in the higher HGI subgroup had a higher risk of incision complications (OR: 3.735, 95% CI: 1.295-10.769). CONCLUSIONS: After adjusting for HbA1c levels, higher HGI (> -0.1) was a risk factor for incision complications, but not for other complications. The risk of overall postoperative complications in patients with lower HGIs (≤ -0.76) should not be ignored.