Low Serum Albumin Predicts Short-term Adverse Outcomes in Surgical Peripheral Artery Disease Patients

It is well known that hypoalbuminemia is associated with adverse would healing, but it is not known to what extent albumin contributes to adverse events in patients with peripheral artery disease (PAD). In our current study, we seek to investigate the association between serum albumin and short-term adverse outcomes for patients with PAD undergoing open surgical intervention. Retrospective analysis of patients with PAD >18 years old with known open surgical intervention from 2013 to 2017 was carried out using the National Surgical Quality Improvement Program database. Patients were stratified by normal (3.30-5.0 mg/dL, n = 12,271) and low serum albumin levels (<3.30 mg/dL, n = 4122). t-tests were used to observe adverse outcomes within 30 days of PAD intervention between patients with normal and low albumin levels. Logistic regression was used to estimate the association between the major amputation (within 30 days of PAD surgical intervention) and serum albumin levels. The logistic regression model included comorbidities that predispose patients to baseline hypoalbuminemia (eg, chronic kidney disease, liver dysfunction, congestive heart failure, and chronic nutritional deficiency). Surgical PAD patients with low serum albumin levels were more likely to have a major amputation reintervention (P < .0001), related readmission (P = .028), and a longer hospital stay (P < .0001) compared with patients with normal albumin levels (Table). On multivariable analysis, patients with low albumin levels had increased odds of major amputation within 30 days of surgery (adjusted odds ratio [aOR]: 2.54, 95% confidence interval [CI]: 1.97-3.28, P < .0001). The model also shows those with kidney failure (estimated glomerular filtration rate < 15), and those who are nursing home residents have increased odds in having major amputation (aOR: 1.75, 95% CI: 0.16-2.64, P = .008; aOR: 1.85, 95% CI: 1.05-3.25, P = .400, respectively). Having diabetes and liver dysfunction also showed significant odds of major amputation on unadjusted regression (OR: 1.50, 95% CI: 1.18-1.90, P = .001; OR: 2.56, 95% CI: 2.06-3.18, P < .0001), but when adjusting for the presence of other relevant covariants the significance was lost in regression analysis. Low serum albumin is associated with adverse short-term outcomes amongst patients with PAD after surgical intervention. Our study illuminates the importance of albumin levels among patients with PAD and suggests that these patients should be appropriately optimized before surgery to decrease short-term adverse effects.TableUnivariate and multivariable logistic regression analysis for major amputation within 30 days of peripheral artery disease (PAD) surgical interventionParametersUnadjusted OR95% CIP valueAdjusted OR95% CIP valueSex FemaleRef––Ref–– Male0.880.69-1.13.3060.890.69-1.14.353Age, years1.000.99-1.02.4701.000.99-1.01.696Albumin Normal rangeRef––Ref–– Abnormally low3.072.41-3.9090Ref––Ref–– 60-890.810.59-1.12.2040.770.56-1.07.121 30-591.020.72-1.43.9280.850.59-1.22.38 15-292.001.19-3.36.0091.230.71-2.11.456 <152.921.98-4.29