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The Impact of Low Preoperative Albumin on Short-term Outcomes after Bariatric Surgery

Amlish B Gondal, MD, Matthew E Mobily, MD, MPH, Iman Ghaderi, MD, MSc, MHPE. University of Arizona

Introduction: Obesity and malnutrition often coexist; malnutrition in turn is an established risk factor for adverse outcomes after surgery. Preoperative albumin is routinely used as surrogate parameter for nutritional status prior to surgery. The aim of this study was to assess the effect of low preoperative albumin on outcomes within 30 days after bariatric surgery.

Methods: An observational study of patients undergoing primary sleeve gastrectomy (SG) and gastric bypass (GB) from the MBSAQIP® PUF 2016 was performed. Chi-square and two tailed t-test analyses were used for categorical and continuous outcomes, respectively, with p<0.05 denoting statistical significance. Logistic regression analysis was performed and odds ratio (OR)along with 95% confidence intervals (CI) were calculated for significant risk factors for Clavien category IV (CD-IV), category V (CD-V) and composite infection rate (CIR) (defined as occurrence of any of the following: pneumonia, superficial SSI, deep SSI, UTI, sepsis, septic shock or clostridium difficile infection) after bariatric surgery.

Results: A totla of 106526 patients were included, 79.7% were female, 73.8% were white, and mean preoperative BMI was 44.3± 13.7 kg/m2. SG was performed in 72% in the patients and 28% patients underwent GB. Ten percent patients (n=11559) had low preoperative albumin (<3.5 g/dL) where the rest had normal albumin. The group with low and normal albumin had comparable baseline demographics and distribution of comorbidities.

When compared to patients with normal albumin, patients with low albumin experienced higher rates of Clavien category V complication (0.2% vs 0.08%, p<0.001), Clavien category IV complications (1.3% vs 0.8%, p<0.001), composite infection rate (2% vs 1.4%, p<0.001) and 30-day readmission rate (5.3%, 3.8%, p<0.01). Those with low preoperative albumin also had a longer length of hospital stay (1.9± 1.7 vs. 1.6±1.2 days). On logistic regression, low preoperative albumin was associated with higher odds of Clavien category V complications (OR= 2.2, CI= 1.4-3.5, p<0.001), Clavien category IV complications (OR= 1.4, CI= 1.1-1.6, p<0.001), and any-cause infection (OR=1.3, CI=1.1-1.6). The regression models had good calibration tested through Hosmer- Lemeshow goodness-of-fit test (for CD-V: χ2 =10.8, p= 0.21; for CD-IV: χ2 =6.8, p= .55; for CIR: χ2 = 3.5, p= 0.89). Figure 1 demonstrates the discriminatory capacity of regression models for CD-V, CD-IV and CIR.

Conclusion: Preoperative albumin levels below 3.5 g/dL are a significant risk factor for serious short term-morbidity after primary bariatric surgery. Further research should focus on nutritional risk stratification and rehabilitation of patients prior to bariatric surgery.

Figure 1: Receiver operating characteristic curves for the models used for A) Clavien category V complication (c- statistic= 0.793); B) Clavien category IV complication (c- statistic= 0.694); C) Any cause infection (c- statistic= 0.630)


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 95784

Program Number: P110

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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