Differential effect of nutritional status on vascular surgery outcomes in a Veterans Affairs versus private hospital setting

BackgroundThe goal of this study was to determine whether preoperative albumin level in vascular surgery patients is predictive of postoperative outcomes in the Veterans Affairs (VA) versus private sector and in open versus endovascular interventions.MethodsA retrospective analysis of male patients with peripheral arterial disease, carotid artery disease, and abdominal aortic aneurysms who underwent open or endovascular interventions at the Jesse Brown VA Medical Center or Northwestern Memorial Hospital from January 2006 to June 2009 was conducted. Preoperative demographics and postoperative outcomes were assessed. Major adverse events (MAE) were defined as myocardial infarction, stroke, or death.ResultsA total of 591 men were included. Preoperative albumin level was significantly higher in VA versus private sector patients (3.6 ± .5 g/dL vs 3.2 ± .8 g/dL, respectively; P = .0001) and endovascular versus open patients (3.6 ± .6 g/dL vs 3.3 ± .7 g/dL, respectively; P < .0001). Albumin level was an independent predictor of MAE (odds ratio [OR], .46; P = .04) and 1-year death (OR, .35; P = .01) for all patients, and was predictive of MAE (OR, .40; P = .05) and 1-year death (OR, .23; P = .0008) in the open cohort.ConclusionsPreoperative malnutrition has important prognostic implications for vascular surgery patients in both the VA and private hospital settings, especially for those patients undergoing open repair.