Faculty Collaboration Database

Hypoalbuminemia is Associated with Mortality in Patients Undergoing Lower Extremity Amputation. Ann Vasc Surg 2021 Nov;77:138-145

Date

08/25/2021

Pubmed ID

34428438

DOI

10.1016/j.avsg.2021.05.047

Scopus ID

2-s2.0-85121353005 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

BACKGROUND: Poor nutritional status is common among patients undergoing lower extremity amputation (LEA). In this study, the association between preoperative hypoalbuminemia, a marker for malnutrition, and postoperative mortality in patients undergoing LEA was explored.

METHODS: Data on patients undergoing LEA between 2005 and 2017 were retrospectively analyzed from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into clinically relevant categories based on their serum albumin level (<2.5, 2.5-3.39, ≥3.4 g/dl) and were further stratified according to amputation level. Operative death was compared across groups and multivariable logistic regression was performed to estimate risk-adjusted odds ratio (AOR).

RESULTS: In 35,383 patients, the rate of 30-day postoperative mortality was 7.6% (n = 2693). Mortality rate was highest in patients with very low albumin levels (11%) as compared to low (6.8%) and normal levels (3.9%). On multivariable analysis, lower albumin levels emerged as a risk-adjusted independent predictor of mortality. After risk-adjustment, patients with very low albumin levels (AOR [95% CI]: 2.25 [1.969-2.56], P < 0.001) and low albumin levels (AOR [95% CI]: 1.42 [1.239-1.616], P < 0.001) had higher odds of mortality when compared to patients with normal albumin levels. On sensitivity analysis, a similar trend was seen in patients undergoing above knee amputation but not in patients undergoing minor amputations.

CONCLUSIONS: In patients undergoing major LEA, hypoalbuminemia is associated with an increased risk of postoperative mortality in a dose response manner, specifically in above knee amputations. Monitoring and optimizing patients' nutritional status before surgery, when possible, may be warranted and should be further explored.

Author List

Chahrour MA, Kharroubi H, Al Tannir AH, Assi S, Habib JR, Hoballah JJ

Author

Abdul Hafiz Al Tannir MD Postdoctoral Fellow in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Biomarkers
Databases, Factual
Female
Humans
Hypoalbuminemia
Lower Extremity
Male
Malnutrition
Middle Aged
Nutrition Assessment
Nutritional Status
Peripheral Arterial Disease
Retrospective Studies
Risk Assessment
Risk Factors
Serum Albumin, Human
Time Factors
Treatment Outcome
United States