title: Hypoalbuminemia Predicts Perioperative Morbidity and Mortality after Infrainguinal Lower Extremity Bypass for Critical Limb Ischemia.
abstract: BACKGROUND
  Poor nutritional status has been associated with a higher risk of morbidity and mortality in general surgery 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, mortality, length of stay (LOS), and readmissions for patients with hypoalbuminemia (serum albumin <3.5 g/dL and <2.8 g/dL) undergoing infrainguinal lower extremity bypass for critical limb ischemia. Multivariable analyses were performed to assess associated risk factors while adjusting for possible confounders.
  
  
  RESULTS
  There were 5,110 LEB identified with an albumin level recorded. There were 2,327 (45.5%) patients with a low preoperative albumin. Patients with a low albumin were more likely to have diabetes, chronic obstructive pulmonary disease, congestive heart failure, previous myocardial infarction, renal failure, dialysis dependence, hypertension, history of transient ischemic attack or stroke, steroid use, impaired functional status, dyspnea at rest, anemia, prior operations within 30 days, preoperative wounds or infections, and a tibial target (P < 0.05). Multivariable analyses showed that low albumin was independently associated with increased mortality (odds ratio [OR]: 1.8, 95% confidence interval [95% CI]: 1.3-2.6, P = 0.001), return to the operating room (OR: 1.4, 95% CI: 1.2-1.6, P < 0.001), and increased LOS (MR: 1.2, 95% CI: 1.1-1.2, P < 0.001). When compared with patients with normal albumin, patients with more severe hypoalbuminemia, less than 2.8 g/dL, showed further increased risk of mortality (OR: 2.5, 95% CI: 1.6-3.8), return to the operating room (OR: 1.6, 95% CI: 1.3-2.0), and prolonged LOS (MR: 1.2, 95% CI: 1.2-1.3).
  
  
  CONCLUSIONS
  Poor preoperative hypoalbuminemia is associated with morbidity and mortality after infrainguinal lower extremity bypass for critical limb ischemia. Evaluation and optimization of nutritional status should be performed preoperatively in this high risk population.
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Peacock
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
authors.forename: Alik
authors.initials: A
authors.lastname: Farber
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Eslami
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kalish
authors.affiliation: Department of Biostatistics, Boston University, Boston, MA.
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.affiliation: Department of Biostatistics, Boston University, Boston, MA.
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA.
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Shah
authors.affiliation: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, MA. Electronic address: Jeffrey.siracuse@bmc.org.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D007511:Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D007902:Length of Stay; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D016017:Odds Ratio; D010359:Patient Readmission; D058729:Peripheral Arterial Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D000075462:Serum Albumin, Human / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D058017:Vascular Grafting / Q000009:adverse effects* / Q000401:mortality
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D000075462:Serum Albumin, Human