Is Elevated HBA1C Associated with Post-Operative Complications in Midfoot Charcot Reconstruction? Myth Or Reality?

Andrew Isaac Christudoss, Bhargava Krishna Balineni, Madhu Tiruveedhula

Introduction: Guidance from the Royal College of Anaesthetists suggests that patients with poorly controlled diabetes are at increased risk of peri-operative complications, wound related issues, and prolonged hospital stays. Nevertheless, surgery remains recommended in urgent and semi-urgent cases. This study aimed to compare post-operative outcomes in patients undergoing Midfoot Charcot reconstruction, stratified by pre-operative HbA1c levels.

Method: Following local governance approval, we retrospectively reviewed patients who underwent midfoot Charcot reconstruction between January 2018 and December 2024. Patients were grouped based on pre-operative HbA1c: Group A (<69 mmol/mol) and Group B (≥69 mmol/mol). Procedures included urgent first-stage debridement, elective second-stage reconstruction or single-stage reconstruction. All patients were treated using standardised protocols involving deep tissue sampling, local antibiotic-eluting agents (Cerament G), and a short course of systemic antibiotics. Post-operative complications and outcomes were compared.

Results: A total of 105 patients were analysed: 82 in Group A and 23 in Group B. Both groups were similar in age and BMI. The median HbA1c was 50.5 mmol/mol in Group A (range: 30–69) and 79 mmol/mol in Group B (range: 70–129). Post-operative complications occurred in 11 patients (13.4%) in Group A and 3 patients (13%) in Group B. Infections occurred in five patients in Group A, with three requiring returns to theatre. In Group B, three patients developed wound infections, but none required re-operation. One patient in Group A required major amputation; none in Group B did. Fourteen patients died during follow-up (10 in Group A, 3 in Group B), all beyond 30 days post-operatively and the cause was unrelated to surgery.

Conclusion: There was no significant difference in post-operative morbidity, mortality, or complication rates between the groups. Elevated HbA1c should not be viewed as a contraindication to surgery in patients with complex diabetic foot pathology.