Association between preoperative glycemic control and outcomes after radical prostatectomy.

Abstract

345 Background: Elevated hemoglobin A1c (A1c) levels are often thought to contribute to adverse perioperative outcomes in diabetic patients. However, data supporting this is limited and conflicting, particularly among patients undergoing radical prostatectomy (RP) for prostate cancer. While some institutions delay surgery in patients with elevated A1c levels, evidence supporting strict thresholds is limited. We evaluated whether preoperative A1c ≥ 8% independently predicts adverse short-term outcomes following RP. Methods: We analyzed the 2023 ACS-NSQIP participant use file with targeted prostatectomy variables. Patients undergoing radical prostatectomy were stratified by preoperative A1c levels (< 8% versus ≥ 8%) measured within 180 days of surgery. Univariate analysis compared 30-day operative outcomes including major, minor, and procedure-specific complications. Multivariate logistic regression adjusted for confounders on significant endpoints, as well as overall complications, readmissions, reoperations, and mortality. Results: Among 7,162 patients undergoing radical prostatectomy, 110 (1.5%) had preoperative A1c ≥ 8%. Patients with elevated A1c demonstrated significantly higher BMI (31.15 vs 29.14 kg/m², p < 0.0001) and increased comorbidities including CHF and hypertension (p < 0.0001). Univariate analysis revealed significant associations between A1c ≥ 8% and wound dehiscence (0.91% vs 0.11%, p = 0.019), anastomotic leak (5.97% vs 1.29%, p = 0.001), and cerebrovascular events (0.91% vs 0.03%, p < 0.0001). However, following multivariable adjustment, these associations were attenuated and no longer significant. No significant differences were observed in rates of major complications, minor complications, infectious complications, procedure-specific complications, readmissions, or reoperations. Conclusions: This multi-institutional analysis demonstrates that while A1c ≥ 8% correlates with select complications in univariate analysis, it does not independently predict adverse outcomes after adjustment for comorbidity burden. Elevated A1c appears to serve as a marker of medical complexity rather than a direct contributor to perioperative morbidity. Although preoperative optimization remains prudent, A1c ≥ 8% is not associated with adverse perioperative outcomes during radical prostatectomy in appropriate surgical candidates. Clinical decision-making should incorporate comprehensive patient assessment rather than relying solely on glycemic thresholds. Radical prostatectomy patient outcomes. HbA1c <8 or No Diabetes Dx N = 7052 HbA1c ≥8 N= 110 P-value Minor Complications 406 (5.76%) 9 (8.18%) 0.2801 Major Complications 405 (5.74%) 9 (8.18%) 0.2768 Urological Complications 378 (5.36%) 7 (6.36%) 0.6433 Return to operating room 58 (0.82%) 2 (1.82%) 0.2556 Readmission 293 (4.15%) 7 (6.36%) 0.2512 Death 4 (0.06%) 0 (0%) 0.8027