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Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair.
J Vasc Surg. 2017 07; 66(1):53-63.e1.JV

Abstract

OBJECTIVE

The effect of preoperative malnutrition on outcomes in patients undergoing major vascular surgery is unclear. We investigated the effects of preoperative hypoalbuminemia, a marker for malnutrition, on outcomes after open abdominal aortic aneurysm repair (OAR) and endovascular abdominal aortic aneurysm repair (EVAR).

METHODS

Patients undergoing OAR or EVAR were identified in the 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program database and stratified into three groups: normal albumin (serum albumin >3.5 g/dL), moderate hypoalbuminemia (2.8-3.5 g/dL), and severe hypoalbuminemia (<2.8 g/dL). Multivariable analyses were performed to assess the association of preoperative hypoalbuminemia with 30-day morbidity and mortality.

RESULTS

We identified 15,002 patients with a recorded preoperative serum albumin who underwent OAR (n = 4956) or EVAR (n = 10,046). Patients in both cohorts with hypoalbuminemia had a higher burden of comorbidity. In OAR patients, multivariable analyses demonstrated that moderate hypoalbuminemia was associated with an increased risk of 30-day mortality (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.02-1.70) and postoperative length of stay (LOS; means ratio [MR], 1.10; 95% CI, 1.04-1.16), whereas severe hypoalbuminemia was associated with increased 30-day mortality (OR, 1.92; 95% CI, 1.37-2.70), reoperation ≤30 days (OR, 1.80; 95% CI, 1.32-2.48), pulmonary complications (OR, 1.40; 95% CI, 1.06-1.86), and postoperative LOS (MR, 1.33; 95% CI, 1.21-1.45). In EVAR patients, moderate hypoalbuminemia was associated with an increased risk of 30-day mortality (OR, 1.90; 95% CI, 1.38-2.62), pulmonary complications (OR, 1.61; 95% CI, 1.26-2.04), reoperation ≤30 days (OR, 1.39; 95% CI, 1.12-1.74), and postoperative LOS (MR, 1.23; 95% CI, 1.18-1.29), whereas severe hypoalbuminemia was associated with increased 30-day mortality (OR, 2.98; 95% CI, 1.96-4.53), pulmonary complications (OR, 1.88; 95% CI, 1.32-2.67), reoperation ≤30 days (OR, 1.54; 95% CI, 1.08-2.19), and postoperative LOS (MR, 1.52; 95% CI, 1.40-1.65).

CONCLUSIONS

Preoperative hypoalbuminemia is associated with increased postoperative morbidity and mortality in a severity-dependent manner among patients undergoing OAR or EVAR. Evaluation and optimization of nutritional status should be performed preoperatively in this high-risk population.

Authors+Show Affiliations

Department of Surgery, Boston Medical Center, Boston, Mass.Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, Mass.Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, Mass.Department of Biostatistics, Boston University, School of Public Health, Boston, Mass.Department of Biostatistics, Boston University, School of Public Health, Boston, Mass.Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, Mass.Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, Mass. Electronic address: jeffrey.siracuse@bmc.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28216349

Citation

Inagaki, Elica, et al. "Preoperative Hypoalbuminemia Is Associated With Poor Clinical Outcomes After Open and Endovascular Abdominal Aortic Aneurysm Repair." Journal of Vascular Surgery, vol. 66, no. 1, 2017, pp. 53-63.e1.
Inagaki E, Farber A, Eslami MH, et al. Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2017;66(1):53-63.e1.
Inagaki, E., Farber, A., Eslami, M. H., Kalish, J., Rybin, D. V., Doros, G., Peacock, M. R., & Siracuse, J. J. (2017). Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. Journal of Vascular Surgery, 66(1), 53-e1. https://doi.org/10.1016/j.jvs.2016.10.110
Inagaki E, et al. Preoperative Hypoalbuminemia Is Associated With Poor Clinical Outcomes After Open and Endovascular Abdominal Aortic Aneurysm Repair. J Vasc Surg. 2017;66(1):53-63.e1. PubMed PMID: 28216349.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. AU - Inagaki,Elica, AU - Farber,Alik, AU - Eslami,Mohammad H, AU - Kalish,Jeffrey, AU - Rybin,Denis V, AU - Doros,Gheorghe, AU - Peacock,Matthew R, AU - Siracuse,Jeffrey J, Y1 - 2017/02/16/ PY - 2016/08/21/received PY - 2016/10/25/accepted PY - 2017/2/22/pubmed PY - 2017/7/14/medline PY - 2017/2/21/entrez SP - 53 EP - 63.e1 JF - Journal of vascular surgery JO - J. Vasc. Surg. VL - 66 IS - 1 N2 - OBJECTIVE: The effect of preoperative malnutrition on outcomes in patients undergoing major vascular surgery is unclear. We investigated the effects of preoperative hypoalbuminemia, a marker for malnutrition, on outcomes after open abdominal aortic aneurysm repair (OAR) and endovascular abdominal aortic aneurysm repair (EVAR). METHODS: Patients undergoing OAR or EVAR were identified in the 2005 to 2012 American College of Surgeons National Surgical Quality Improvement Program database and stratified into three groups: normal albumin (serum albumin >3.5 g/dL), moderate hypoalbuminemia (2.8-3.5 g/dL), and severe hypoalbuminemia (<2.8 g/dL). Multivariable analyses were performed to assess the association of preoperative hypoalbuminemia with 30-day morbidity and mortality. RESULTS: We identified 15,002 patients with a recorded preoperative serum albumin who underwent OAR (n = 4956) or EVAR (n = 10,046). Patients in both cohorts with hypoalbuminemia had a higher burden of comorbidity. In OAR patients, multivariable analyses demonstrated that moderate hypoalbuminemia was associated with an increased risk of 30-day mortality (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.02-1.70) and postoperative length of stay (LOS; means ratio [MR], 1.10; 95% CI, 1.04-1.16), whereas severe hypoalbuminemia was associated with increased 30-day mortality (OR, 1.92; 95% CI, 1.37-2.70), reoperation ≤30 days (OR, 1.80; 95% CI, 1.32-2.48), pulmonary complications (OR, 1.40; 95% CI, 1.06-1.86), and postoperative LOS (MR, 1.33; 95% CI, 1.21-1.45). In EVAR patients, moderate hypoalbuminemia was associated with an increased risk of 30-day mortality (OR, 1.90; 95% CI, 1.38-2.62), pulmonary complications (OR, 1.61; 95% CI, 1.26-2.04), reoperation ≤30 days (OR, 1.39; 95% CI, 1.12-1.74), and postoperative LOS (MR, 1.23; 95% CI, 1.18-1.29), whereas severe hypoalbuminemia was associated with increased 30-day mortality (OR, 2.98; 95% CI, 1.96-4.53), pulmonary complications (OR, 1.88; 95% CI, 1.32-2.67), reoperation ≤30 days (OR, 1.54; 95% CI, 1.08-2.19), and postoperative LOS (MR, 1.52; 95% CI, 1.40-1.65). CONCLUSIONS: Preoperative hypoalbuminemia is associated with increased postoperative morbidity and mortality in a severity-dependent manner among patients undergoing OAR or EVAR. Evaluation and optimization of nutritional status should be performed preoperatively in this high-risk population. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/28216349/Preoperative_hypoalbuminemia_is_associated_with_poor_clinical_outcomes_after_open_and_endovascular_abdominal_aortic_aneurysm_repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(16)31673-1 DB - PRIME DP - Unbound Medicine ER -