Preoperative Hyperglycemia in GYN Surgery: Perioperative Considerations.

IMPORTANCE: There is not clear consensus on perioperative A1C goals in gynecologic (GYN) surgery. OBJECTIVE: To review current literature regarding glycemic control and postoperative outcomes for major GYN surgery for benign, urogynecologic, or oncologic indications. EVIDENCE ACQUISITION: Review conducted using the following databases: MEDLINE via PubMed, Embase via Elsevier, and the Web of Science Core Collection via Clarivate. Included studies were peer-reviewed articles published (1990-current) that examined postoperative complications following major GYN surgery, including hysterectomy, myomectomy, debulking, adnexal mass, vulvectomy, sacrocolpopexy, and percutaneous neurostimulator implants. Data extracted included study design, demographic data, type of surgery, complications, and measure of glycemic control. RESULTS: Of 698 studies, 14 were included: 4 in benign GYN literature, 3 in urogynecology literature, and 7 in GYN oncology literature. In benign GYN literature, hemoglobin A1C values greater than 9% were directly associated with surgical site infection (SSI). In urogynecology, A1C greater than 8% was associated with increased urinary tract infections, wound separation, midurethral sling failure, and composite complications. Finally, in GYN oncology, an A1C greater than or equal to 7% was associated with decreased recurrence-free survival and cancer-specific survival. Preoperative glucose above 110 mg/dL was associated with increased risk of deep vein thrombosis (DVT) in ovarian cancer patients and risk of SSI in endometrial cancer patients. CONCLUSIONS AND RELEVANCE: High preoperative A1C is associated with worse postoperative outcomes in the setting of major GYN surgeries. Here we provide guidelines by GYN subspecialty.