Elevated Hemoglobin A1c Is Associated With Lower Socioeconomic Position and Increased Postoperative Infections and Longer Hospital Stay After Cardiac Surgical Procedures

Background. Patients with elevated hemoglobin A1c (HbA1c) levels have an increased risk of adverse shortand long-term outcomes after cardiac surgical procedures. Whether elevated HbA1c levels are associated with lower socioeconomic position (SEP) has been unknown. Methods. All adult patients undergoing cardiac surgical procedures at Kansas University Medical Center in Kansas City, Kansas in 2014 (n = 567) were reviewed. Of those patients, 531 had a preoperative HbA1c level measured. HbA1c was delineated as 7% or lower or greater than 7%. The two aims of this study were to evaluate a possible association of HbA1c and SEP and to evaluate for a possible association of HbA1c levels and poor outcomes after cardiac surgical procedures. The primary postsurgical outcomes were infections and intensive care unit length of stay. Results. HbA1c levels greater than 7% were associated with lower SEP (p = 0.005) and with increased risk of infection postoperatively (p < 0.001). Total hospital length of stay tended to be longer for patients with HbA1c greater than 7% (p = 0.009). Conclusions. Elevated HbA1c levels are associated with lower SEP. This association not only may hinder the ability to correct HbA1c levels, but also may impart a risk for elevated HbA1c levels. Additionally, patients who present for cardiac operations with HbA1c greater than 7% have an increased risk of postoperative infections. (C) 2017 by The Society of Thoracic Surgeons