# The Association Between HbA1c Level and the Outcomes of Rotator Cuff Repair Surgery in Patients Managed at a Tertiary Center: A Retrospective Cohort Study

## TL;DR

This study found that preoperative HbA1c levels did not affect the outcomes of rotator cuff surgery, but other health conditions like hypertension and liver disease did.

## Contribution

The study is the first to show that HbA1c levels alone may not predict surgical outcomes in rotator cuff repair, emphasizing the role of other comorbidities.

## Key findings

- Preoperative HbA1c levels were not correlated with functional improvements or complications after surgery.
- Hypertension and liver disease were associated with higher postoperative HbA1c levels.
- Comprehensive health assessment is important for optimizing surgical outcomes in these patients.

## Abstract

Background

Rotator cuff tears are a leading cause of shoulder dysfunction and often require surgical repair. Diabetes mellitus can impair tendon healing through chronic inflammation and poor glycemic control, reflected by elevated glycated hemoglobin (HbA1c) levels. This study aimed to explore the association between HbA1c levels and the outcomes of rotator cuff repair surgery in patients managed at a tertiary center.

Methodology

This retrospective cohort study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, from February 2020 to February 2025. Data were collected on demographics, pre- and postoperative details, outcomes, and comorbidities. Data were analyzed using Fisher’s exact test, Spearman’s correlation, independent-sample t-tests, and descriptive statistics, conducted using SPSS version 29.0.0 (IBM Corp., Armonk, NY, USA).

Results

Of the 79 eligible patients, 38 were excluded due to incomplete HbA1c data, and 41 were analyzed. Most patients were female (28; 68.3%) with a mean age of 57.1 ± 7.6 years (range = 39-69 years). The average body mass index was 30.2 ± 4.3 kg/m², with 18 (43.9%) patients classed as overweight and 19 (46.3%) obese. Common comorbidities included dyslipidemia (32; 78.0%), hypertension (23; 56.1%), and diabetes (21; 51.2%). Preoperative HbA1c showed no correlation with functional improvements in abduction (r = 0.132, p = 0.455), forward flexion (r = −0.082, p = 0.646), external rotation (r = 0.292, p = 0.187), or return to work (r = 0.008, p = 0.961). Complication rates were similar between controlled (6; 66.7%) and uncontrolled (3; 33.3%) HbA1c groups (p = 0.707). Hypertension (B = 1.327, p = 0.032) and liver disease (B = 3.913, p = 0.009) predicted higher postoperative HbA1c, while other comorbidities showed no significant associations.

Conclusions

Preoperative HbA1c was not associated with postoperative functional outcomes or complications. However, certain comorbidities were linked to higher postoperative HbA1c, suggesting that overall health conditions may influence recovery more than glycemic control alone. These findings highlight the importance of comprehensive perioperative assessment and tailored management strategies to optimize outcomes in rotator cuff repair patients.