Michael Mazzei, MD1, Jeremy Van De Rijn2, Dominic Recco2, Rajiv Raghavan, MD1, Matthew Knouse, MD1, Michael Edwards, MD1, Eric Velazquez, MD1. 1Temple University Hospital, 2Temple University Lewis Katz School of Medicine
Introduction: While morbidly obese patients have an excess of stored calories, this is not necessarily commensurate with adequate nourishment. Nutritional deficiencies are commonly identified in the bariatric population; in particular, hypoalbuminemia has been identified in up to 15% of patients prior to bariatric surgery. Protein malnutrition has been implicated as a risk factor for poor outcomes in a number of surgical populations, and may represent a potentially modifiable preoperative risk factor in the bariatric patient. In this study, we evaluate the effects of hypoalbuminemia on 30-day bariatric outcomes.
Methods: From the American College of Surgeons Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) database, we identified patients with albumin levels recorded within 30 days prior to weight loss surgery in 2015-2016. An unmatched cohort analysis as well as a 1:1 propensity-matched cohort analysis was performed to assess the relationship between preoperative albumin levels and thirty-day postoperative outcomes and complication rates.
Results: Of the 195,407 patients with albumin levels recorded in the thirty days prior to weight loss surgery, 12,124 (6.2%) had protein malnutrition (albumin <3.5 g/dl). At baseline, hypoalbuminemic patients had higher BMI (48.9 vs. 45.1, p<0.001) with significantly increased rates of comorbid conditions, including heart disease, diabetes, and COPD. These patients had longer postoperative length of stay (2.1 vs 1.7 days, p<0.001), and higher rates of readmission (6.1% vs. 4.3%, RR = 1.41, p = 0.001), unplanned ICU admission (1.4% vs. 0.8%, RR = 1.77, p<0.001), re-intervention (2.5% vs. 1.5%, RR = 1.61, p<0.001), and wound infections (1.4% vs. 0.8%, RR = 1.59, p <0.001). On 1:1 propensity-matched analysis of 24,064 patients controlling for age, BMI, operation type, and major comorbidities, the findings of poorer outcomes among patients with preoperative protein malnutrition were preserved, including higher rates of readmission (6.1% vs. 5.1%, RR = 1.18, p = 0.004), re-intervention (2.4% vs. 1.8%, RR = 1.33, p = 0.002), and wound infections (1.3% vs. 1.0%, RR = 1.33, p = 0.019).
Conclusions: In this large database analysis, protein malnutrition independently increases the risk of 30-day adverse outcomes following primary bariatric surgery. This is especially true in the context of a higher prevalence of comorbid conditions in this patient population, which further increases the risk. Because hypoalbuminemia may be viewed as a modifiable comorbid condition, weight loss surgery should be deferred for patients with protein malnutrition until this condition is corrected preoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95790
Program Number: P133
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster