Low Preoperative Albumin Predicts Worse Outcomes Following Open but not Endovascular Revascularization for Chronic Mesenteric Ischemia
Ajit Rao, MD, Peter Faries, MD, Michael Marin, MD, Ageliki Vouyouka, MD.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Objectives: Clinical manifestations of chronic mesenteric ischemia (CMI) are uncommonly seen in practice in part due to an extensive network of visceral collateralization. Given the infrequency of treatment for CMI, limited data is available on what risk factors predispose patients to worse outcome following revascularization. We sought to identify the consequences of low preoperative albumin (< 3.5 g/dL) on perioperative morbidity and mortality in CMI patients undergoing either open or endovascular revascularization.
Methods: We reviewed data from 491 patients who underwent revascularization from January 2010 to December 2014 at all hospitals in North America participating in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). Trauma, emergencies, aneurysms, and acute mesenteric ischemia cases were excluded. We compared the 30-day outcomes of 186 patients who underwent endovascular revascularization with 305 patients who underwent open surgical repair.
Results: The mean age of all patients undergoing revascularization was 68.7 years and the majority of patients were white (85.9%) and female (73.5%). The rates of comorbidities between the two groups were comparable. Patients undergoing open revascularization had higher mortality rates (7.2% vs 2.2%, P<.001) and perioperative complications (table I). Low preoperative albumin predicted worse outcomes in the open surgical revascularization, including higher rates of pneumonia (14.2% vs 4.7%, P=.004), septic shock (8.0% vs 2.6%, P=.031), wound dehiscence (2.7% vs 0.0%, P=.023), and bowel resection (8.0 vs. 2.6%, P=.034). Outcomes in the endovascular group were not significantly impacted by preoperative albumin level. Notably, only 21.8% of all patients were underweight (BMI <18.5) and preoperative weight loss, BMI, and bilirubin did not significantly predict worse outcomes in either group.
Conclusions: In the contemporary era, patients with CMI that undergo open surgical revascularization have higher perioperative morbidity and mortality when compared to endovascular intervention. Low preoperative albumin can be used as a marker for patients who may have unfavorable outcomes following open but not endovascular revascularization.
|Variable||All Patients||Normal Albumin Level||Low Albumin Level||P-value|
|Bowel Resection (open), %||4.6||2.6||8.0||.697|
|Conduit Failure (open), %||0.7||0.0||1.8||.139|
|Pneumonia (open), %||8.2||4.7||14.2||.004|
|Septic Shock (open), %||4.6||2.6||8.0||.031|
|Wound Dehiscence (open), %||1.0||0.0||2.7||.023|
|Bowel Resection (endo), %||1.6||0.0||2.2||.283|
|Conduit Failure (endo), %||0.0||0.0||0.0||--|
|Pneumonia (endo), %||1.6||0.0||2.2||.283|
|Septic Shock (endo), %||1.1||1.5||0.0||.382|
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