Long-term wound morbidity and hernia recurrence in diabetic patients with HbA1c ≥ 8.5% undergoing open transversus abdominis release: a descriptive longitudinal follow-up of a single-center cohort.

backgroundPreoperative glycemic control, as measured by HbA1c, is widely used in risk stratification for diabetic patients undergoing abdominal wall reconstruction (AWR). In a prior analysis, our group demonstrated that among diabetic patients undergoing open ventral hernia repair (VHR) with transversus abdominis release (TAR), preoperative HbA1c levels did not correlate with short-term wound morbidity. This study evaluates long-term outcomes in patients with poor preoperative glycemic control (HbA1c ≥ 8.5%) undergoing open AWR with TAR.

methodsAdult diabetic patients with HbA1c ≥ 8.5% who underwent open, elective, clean VHR with concurrent TAR and permanent synthetic mesh at the Cleveland Clinic Center for Abdominal Core Health between January 2014 and January 2024 were identified from the Abdominal Core Health Quality Collaborative (ACHQC) and followed for a minimum of 12 months. Assessed outcomes included wound morbidity, mesh-related complications, and hernia recurrence. Threshold analysis using ROC methodology and logistic spline regression was performed to evaluate the discriminative capacity of HbA1c within the poor glycemic control range.

resultsOf 48 patients with HbA1c ≥ 8.5%, 46 (95.8%) completed long-term follow-up at a median of 22.3 months. Long-term SSOPI and partial mesh removal rates were 4.3% and 2.2%, respectively. Pragmatic hernia recurrence was observed in 4 patients (8.7%), all of whom had experienced early wound morbidity (4/4); three of the four had also undergone partial mesh excision or removal (3/4). No recurrences were documented in patients with uncomplicated postoperative courses. Threshold analysis yielded an AUC of 0.37, indicating no meaningful discriminative threshold within the observed HbA1c range.

conclusionAmong diabetic patients with HbA1c ≥ 8.5% undergoing open AWR with TAR at a high-volume center, long-term wound and recurrence rates were within the range reported for general TAR cohorts. These descriptive findings, while limited by sample size and the absence of an internal comparator, support the hypothesis that preoperative HbA1c may have limited stand-alone discriminative capacity in this setting and warrant confirmation in adequately powered comparative analyses, including the longitudinal multi-stratum cohort currently ongoing at our institution.