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Preoperative Nutrition Status and Clinical Outcomes after Infrainguinal Lower Extremity Bypass
Matthew R. Peacock, Alik Farber, M.D., Mohammad H. Eslami, M.D., Jeffrey A. Kalish, M.D., Denis Rybin, M.S., Gheorghe Doros, Ph.D., Nishant K. Shah, Jeffrey J. Siracuse, M.D..
Boston University, Boston, MA, USA.
Objectives: Poor nutritional status is associated with a higher risk of morbidity and mortality in general surgical patients, however outcomes in vascular surgery patients are unclear. Our goal was to determine the effect of poor nutritional status on perioperative morbidity and mortality after lower extremity bypass (LEB).
Methods: The 2005-2012 National Surgical Quality Improvement Program was analyzed to determine associated complications, length of stay (LOS), and readmissions with poor nutritional status (serum albumin <3.5 g/dL). Multivariate analyses were performed for risk-adjusted outcomes.
Results: There were 5,110 LEB identified with an albumin level recorded of which 2,327 (45.5%) patients had low preoperative albumin. Patients with a low albumin were more likely to have diabetes, pulmonary complications (pneumonia, unplanned intubation, prolonged intubation) congestive heart failure, previous myocardial infarction, renal failure, dialysis dependence, hypertension, history of transient ischemic attack, steroid use, totally dependent functional status, dyspnea at rest, preoperative hematocrit <30, prior operations within 30 days and preoperative wounds or infections (P<.02). Multivariable analysis showed that low albumin was significantly associated with increased mortality (OR 1.8, 95% CI 1.3-2.6, P=.001), pulmonary complications (OR 1.5, 95% CI 1.1-2, P=.009), return to the operating room (OR 1.4, 95% CI 1.2-1.6, P<.001), increased LOS (OR 1.2, 95% CI 1.1-1.2, P<.001), and 30 day readmission (OR 1.5, 95% CI 1.0-2.3, P=.03). When stratified by body mass index, obese patients with low albumin were at the highest risk for pulmonary complications (OR 2.3, 95% CI 1.3-4.2, P=.007), readmission (OR 2.2, 95% CI 1.1-4.6, P=.028), and increased LOS (OR 1.2, 95% CI 1.1-1.3, P<.001).
Conclusions: Poor preoperative nutritional status is associated with morbidity and mortality in lower extremity bypass patients. Evaluation and optimization of nutritional status should be performed preoperatively in this high risk population.
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