The Role of Glycemic Status in Adverse Outcomes Following ENT Surgery.

Abstract

Poor glycemic control is a known risk factor for adverse surgical outcomes, yet its impact in otolaryngologic (ENT) procedures remains underexplored. This study investigates the association between preoperative hemoglobin A_1c (HbA_1c) levels and postoperative outcomes in ENT surgical patients, while also assessing the prevalence of unrecognized dysglycemia. ENT patients within the ACS-NSQIP database (2021-2023) were stratified into glycemic groups based on diabetes diagnosis and HbA_1c thresholds. Multivariable logistic regression assessed the independent association of HbA_1c and composite outcomes, which included any-, surgical-, and medical complications, readmission, and reoperation. Among 14,034 ENT patients, 6.2% had HbA_1c values indicative of undiagnosed diabetes. Complication rates increased with worsening glycemic control, a persisting trend across many procedures. Multivariate analysis revealed that patients with a diabetes diagnosis and poor glycemic control experienced higher odds of any- (OR 1.4, 95% CI 1.2-1.8, p = 0.001), surgical- (OR 1.4, 95% CI 1.1-2.0, p = 0.02), and medical complications (OR 1.9, 95% CI 1.3-2.7, p < 0.001), as well as hospital readmissions (OR 1.5, 95% CI 1.0-2.1, p = 0.04), while those with undiagnosed pre-diabetes demonstrated lower odds of medical complications (OR 0.66, 95% CI 0.45-0.96, p = 0.03) when compared to healthy individuals. Glycemic status is a strong predictor of short-term postoperative complications in ENT surgery. Importantly, a substantial portion of patients had undiagnosed diabetes or prediabetes, emphasizing the need for preoperative HbA_1c screening to identify at-risk individuals and enable early intervention.