Abstract BACKGROUND: The relationship between hyperglycemia and adverse outcomes following surgery has been widely documented. Long-term glucose control has been recognized as a risk factor for postoperative complications. In the foot and ankle literature, long-term glycemic control as a potential perioperative risk factor is not well studied. Our goal was to investigate if hemoglobin A1c (HbA1c) was independently associated with postoperative complications in a retrospective cohort study. METHODS Three hundred and twenty-two patients with a diagnosis of diabetes mellitus were enrolled in the study to assess risk factors associated with postoperative complications following foot and ankle surgery. RESULTS Bivariate analyses showed that HbA1c and having at least one comorbidity was associated with postoperative infections. However, after adjusting for other covariates, the only significant factor was HbA1c, with each increment of one percent increasing the odds of infection by a factor of 1.59 (95% CI 1.28-1.99). For postoperative wound healing complication, bivariate analyses showed that BMI, having at least one comorbidity, and HbA1c were the significant factors. After adjusting for other covariates, the only significant factors for developing postoperative wound complications were having at least one comorbidity (OR = 2.03, 95% CI 1.22-3.37) and HbA1c (each1%)(OR = 1.25, 95%CI = 1.02-1.53). CONCLUSIONS In this retrospective study, hemoglobin A1c had the strongest association with postoperative complications following foot and ankle surgery in patients with diabetes.