Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk?
BACKGROUND
The deleterious effects of perioperative malnutrition on recovery after general surgery are established. Since the effects of perioperative malnutrition on recovery after vascular surgery are not known, we examined the effects of nutritional status, and risk factors predictive of malnutrition, on outcome after vascular surgery.


METHODS
The records of all open index vascular cases (abdominal aortic aneurysm [AAA] repair, carotid endarterectomy [CEA], lower extremity bypass) performed at the Veterans Affairs (VA) Connecticut between July 2004 and June 2005 were reviewed. The primary outcome was mortality; secondary outcomes included infection and nutritional risk index (NRI) scores.


RESULTS
Sixty-eight open vascular cases were performed during the study period. Nutritional depletion developed in 55% of patients and was more likely in patients undergoing AAA (85%) or bypass (77%) than CEA (30%; P = .0005). Patients who developed malnutrition had similar mortality as patients who did not develop postoperative malnutrition (6.1% vs. 3.7%; P = .68); however, malnourished patients had higher rates of postoperative infection (24.2% vs. 3.7%; P = .03). Chronic renal failure was the only patient-associated risk factor predictive of postoperative nutritional depletion (odds ratio 5.9, confidence interval 1.0 to 33.6; P = .04).


CONCLUSIONS
Patients undergoing major open vascular surgery have high rates of postoperative malnutrition, with patients undergoing AAA repair having the highest rates of postoperative malnutrition and infection. Patients with chronic renal failure undergoing vascular surgery are associated with increased risk for postoperative malnutrition and may be a group to target for perioperative risk factor modification and nutritional supplementation.
Westvik
Tormod S
TS
Department of Surgery, Veterans Affairs Connecticut Health Care Systems, West Haven, CT 06516, USA.
Krause
Lauren K
LK
Pradhan
Sanjeev
S
Westvik
Hilde H
HH
Maloney
Stephen P
SP
Rutland
Reuben
R
Kudo
Fabio A
FA
Muto
Akihito
A
Leite
Jose O M
JO
Cha
Charles
C
Gusberg
Richard J
RJ
Dardik
Alan
A
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology*; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010288:Parenteral Nutrition; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000453:epidemiology*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*