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The Degree of Preoperative Hypoalbuminemia Is Associated with Risk of Postoperative Complications in Metabolic and Bariatric Surgery Patients

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Abstract

Background

The incidence and impact of hypoalbuminemia in bariatric surgery patients is poorly characterized. We describe its distribution in laparoscopic sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB) patients undergoing primary or revision surgeries and assess its impact on postoperative complications.

Methods

The Metabolic and Bariatric Surgery Quality Improvement Program Database (2015 to 2021) was analyzed. Hypoalbuminemia was defined as Severe (< 3 g/dL), Moderate (3 ≤ 3.5 g/dL), Mild (3.5 ≤ 4 g/dL), or Normal (≥ 4 g/dL). Multivariable logistic regression was performed to calculate odds ratios of postoperative complications compared to those with Normal albumin after controlling for procedure, age, gender, race, body mass index, functional status, American Society of Anesthesia class, and operative length.

Results

A total of 817,310 patients undergoing Primary surgery and 69,938 patients undergoing Revision/Conversion (“Revision”) surgery were analyzed. The prevalence of hypoalbuminemia was as follows (Primary, Revision): Severe, 0.3%, 0.6%; Moderate, 5.2%, 6.5%; Mild, 28.3%, 31.4%; Normal, 66.2%, 61.4%. Primary and Revision patients with hypoalbuminemia had a significantly higher prevalence (p < 0.01) of several co-morbidities, including hypertension and insulin-dependent diabetes. Any degree of hypoalbuminemia increased the odds ratio of several complications in Primary and Revision patients, including readmission, intervention, and reoperation. In Primary patients, all levels of hypoalbuminemia also increased the odds ratio of unplanned intubation, intensive care unit admission, and venous thromboembolism requiring therapy.

Conclusion

Over 30% of patients present with hypoalbuminemia. Even mild hypoalbuminemia was associated with an increased rate of several complications including readmission, intervention, and reoperation. Ensuring nutritional optimization, especially prior to revision surgery, may improve outcomes in this challenging population.

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Data Availability

It is already mentioned that this data is publically available via the MBSAQIP.

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Author information

Authors and Affiliations

  1. Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA

    Lee D. Ying & Emily J. Zolfaghari

  2. Yale School of Medicine, New Haven, CT, USA

    Grace F. Chao, Joseph Canner, Elena Graetz, Saber Ghiassi, Jennifer S. Schwartz, Eric B. Schneider & Karen E. Gibbs

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  1. Lee D. Ying
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Correspondence to Lee D. Ying.

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Key Points

• Over 30% of VSG and RYGB patients have preoperative hypoalbuminemia.

• Hypoalbuminemia is associated with a greater co-morbidity burden.

• Hypoalbuminemia increases risk of readmission and reoperation.

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Ying, L.D., Chao, G.F., Canner, J. et al. The Degree of Preoperative Hypoalbuminemia Is Associated with Risk of Postoperative Complications in Metabolic and Bariatric Surgery Patients. OBES SURG 34, 51–70 (2024). https://doi.org/10.1007/s11695-023-06944-1

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