title: Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk?
abstract: 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.
authors.affiliation: Department of Surgery, Veterans Affairs Connecticut Health Care Systems, West Haven, CT 06516, USA.
authors.forename: Tormod S
authors.initials: TS
authors.lastname: Westvik
authors.forename: Lauren K
authors.initials: LK
authors.lastname: Krause
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Pradhan
authors.forename: Hilde H
authors.initials: HH
authors.lastname: Westvik
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Maloney
authors.forename: Reuben
authors.initials: R
authors.lastname: Rutland
authors.forename: Fabio A
authors.initials: FA
authors.lastname: Kudo
authors.forename: Akihito
authors.initials: A
authors.lastname: Muto
authors.forename: Jose O M
authors.initials: JO
authors.lastname: Leite
authors.forename: Charles
authors.initials: C
authors.lastname: Cha
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gusberg
authors.forename: Alan
authors.initials: A
authors.lastname: Dardik
mesh_terms: 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*