Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk?
Presented at the 30th Annual Surgical Symposium of the Association of VA Surgeons, Cincinnati, Ohio, May 7–9, 2006
Received 17 May 2006; received in revised form 31 July 2006
Abstract
Background
The deleterious effects of perioperative malnutrition on recovery after general surgery are established. Since the effects of perioperative malnutrition on recovery after vascular surgery are not known, we examined the effects of nutritional status, and risk factors predictive of malnutrition, on outcome after vascular surgery.
Methods
The records of all open index vascular cases (abdominal aortic aneurysm [AAA] repair, carotid endarterectomy [CEA], lower extremity bypass) performed at the Veterans Affairs (VA) Connecticut between July 2004 and June 2005 were reviewed. The primary outcome was mortality; secondary outcomes included infection and nutritional risk index (NRI) scores.
Results
Sixty-eight open vascular cases were performed during the study period. Nutritional depletion developed in 55% of patients and was more likely in patients undergoing AAA (85%) or bypass (77%) than CEA (30%; P = .0005). Patients who developed malnutrition had similar mortality as patients who did not develop postoperative malnutrition (6.1% vs. 3.7%; P = .68); however, malnourished patients had higher rates of postoperative infection (24.2% vs. 3.7%; P = .03). Chronic renal failure was the only patient-associated risk factor predictive of postoperative nutritional depletion (odds ratio 5.9, confidence interval 1.0 to 33.6; P = .04).
Conclusions
Patients undergoing major open vascular surgery have high rates of postoperative malnutrition, with patients undergoing AAA repair having the highest rates of postoperative malnutrition and infection. Patients with chronic renal failure undergoing vascular surgery are associated with increased risk for postoperative malnutrition and may be a group to target for perioperative risk factor modification and nutritional supplementation.
aDepartment of Surgery, Veterans Affairs Connecticut Health Care Systems, West Haven, CT, USA
bYale University School of Medicine, New Haven, CT, USA
Corresponding author. VA Connecticut Health Care Systems, Department of Surgery, 950 Campbell Ave, Building 1, Room 4-220, West Haven, CT 06516. Tel.: +1-203-932-5711; fax: +1-203-937-3868.
ABSTRACT