Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass

Vasc Endovascular Surg. 2019 Nov;53(8):629-635. doi: 10.1177/1538574419868869. Epub 2019 Aug 15.

Abstract

Introduction: Preoperative hypoalbuminemia is associated with poor outcomes across many surgical fields. However, the effects on outcomes after lower extremity bypass (LEB), particularly over the 90-day global surgical period, are unclear. Our goal was to analyze the effect of hypoalbuminemia within 90 days after LE bypass.

Methods: We performed a single-center retrospective review of all infrainguinal LEBs from 2007 to 2017. Patients were categorized into 3 preoperative albumin groups: severe hypoalbuminemia (SH; albumin ≤2.8g/dL), mild-moderate hypoalbuminemia (MH; albumin >2.8-3.5g/dL), and normal albumin (albumin >3.5g/dL). Patient and procedural details were recorded. Outcomes analyzed included wound infection, myocardial infarction (MI), pulmonary complications, early graft occlusion (≤30 days), mortality, and emergency department (ED) presentation and readmissions within 30 and 90 days. Multivariable analysis was performed.

Results: We identified 313 patients undergoing LEB-45 (14.4%) with SH, 133 (42.5%) with MH, and 135 (43.1%) with normal albumin. Overall, the mean age was 65.7 years, and 63.3% were male. The SH group more frequently had tissue loss, diabetes, hypertension, end-stage renal disease, preoperative hematocrit <30%, and patients admitted preoperatively (all P < .05). There were no significant differences in wound complications, MI, pulmonary complications, early graft occlusion, 30-day or 90-day mortality, and 30-day ED presentation. Severe hypoalbuminemia compared to MH and normal albumin, respectively, had significantly higher rates of 30-day readmission (40% vs 30.8% vs 17.8%, P = .005), 90-day ED presentation (55.6% vs 33.8% vs 29.6%, P = .006), and 90-day readmission (66.7% vs 48.9% vs 35.6%, P = .001). Multivariable analysis showed that SH was independently associated with 90-day ED presentation (odds ratio [OR]: 2.8, 95% confidence interval [CI]: 1.23-6.36, P = .014) and 90-day readmission (OR: 2.63, 95% CI: 1.21-5.71, P = .015).

Conclusion: Our study suggests that patients with SH undergoing LEB had similar perioperative complication rates compared to normal albumin and MH groups, and SH was independently associated with 90-day ED presentation and readmission. Further studies are needed to assess other factors associated with ED visits and readmission.

Keywords: albumin; bypass; emergency department; hypoalbuminemia; readmission; vascular surgery.

MeSH terms

  • Aged
  • Biomarkers / blood
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / mortality
  • Databases, Factual
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Hypoalbuminemia / blood
  • Hypoalbuminemia / complications*
  • Hypoalbuminemia / diagnosis
  • Hypoalbuminemia / mortality
  • Lower Extremity / blood supply*
  • Male
  • Middle Aged
  • Patient Readmission*
  • Peripheral Arterial Disease / complications
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / mortality
  • Peripheral Arterial Disease / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Saphenous Vein / transplantation*
  • Serum Albumin, Human / analysis*
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • ALB protein, human
  • Biomarkers
  • Serum Albumin, Human