Preoperative Hypoalbuminemia is a Risk Factor for Early and Late Mortality in Patients Undergoing Endovascular Juxtarenal and Thoracoabdominal Aortic Aneurysm Repair

Wohlauer, Max V.; Brier, Corey; Kuramochi, Yuki; Eagleton, Matthew J.

doi:10.1016/j.avsg.2017.03.058

Cited by 15 publications

(10 citation statements)

References 17 publications

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“…This finding was confirmed also in candidates for juxtarenal and thoracoabdominal aortic aneurysm repairs, independently of the type of the surgery (open vs. endovascular abdominal aortic aneurysm repair) 76,77. Patients with severe hypalbuminemia (albumin levels lower than 2.4 g/dl) have increased 30-day mortality, which can be reduced by a controlled preoperative nutritional intake 76,78. Based on findings, a guiding list was created to help the preoperative clinical assessment of vascular patients.…”

Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 61%

“…After lower extremity bypass surgeries, a higher morbidity and mortality was observed in patients with preoperative hypalbuminemia 76. This finding was confirmed also in candidates for juxtarenal and thoracoabdominal aortic aneurysm repairs, independently of the type of the surgery (open vs. endovascular abdominal aortic aneurysm repair) 76,77. Patients with severe hypalbuminemia (albumin levels lower than 2.4 g/dl) have increased 30-day mortality, which can be reduced by a controlled preoperative nutritional intake 76,78.…”

Section: Discussionmentioning

confidence: 99%

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<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

Czobor¹,

Lehot²,

Holndonner–Kirst³

et al. 2019

TCRM

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Frailty is presumably associated with an elevated risk of postoperative mortality and adverse outcome in vascular surgery patients. The aim of our review was to identify possible methods for risk assessment and prehabilitation in order to improve recovery and postoperative outcome. The literature search was performed via PubMed, Embase, OvidSP, and the Cochrane Library. We collected papers published in peer-reviewed journals between 2001 and 2018. The selection criterion was the relationship between vascular surgery, frailty and postoperative outcome or mortality. A total number of 52 publications were included. Frailty increases the risk of non-home discharge independently of presence or absence of postoperative complications and it is related to a higher 30-day mortality and major morbidity. The modified Frailty Index showed significant association with elevated risk for post-interventional stroke, myocardial infarction, prolonged in-hospital stays and higher readmission rates. When adjusted for comorbidity and surgery type, frailty seems to impact medium-term survival (within 2 years). Preoperative physical exercising, avoidance of hypalbuminemia, psychological and cognitive training, maintenance of muscle strength, adequate perioperative nutrition, and management of smoking behaviours are leading to a reduced length of stay and a decreased incidence of readmission rate, thus improving the effectiveness of early rehabilitation. Pre-frailty is a dynamically changing state of the patient, capable of deteriorating or improving over time. With goal-directed preoperative interventions, the decline can be prevented.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

Czobor¹,

Lehot²,

Holndonner–Kirst³

et al. 2019

TCRM

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“…The same result could be observed for hypoalbuminemia. Although being well known as a marker of frailty, hypoalbuminemia did not show to be a significant predictor for severe complications after NSS (OR 0.93) or for hospital re-admission (OR 0.58) [ 33 , 34 ]. We assume that both factors themselves are not the most decisive components in the context of the frailty syndrome.…”

Section: Discussionmentioning

confidence: 99%

Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

et al. 2021

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Purpose To examine frailty and comorbidity as predictors of outcome of nephron sparing surgery (NSS) and as decision tools for identifying candidates for active surveillance (AS) or tumor ablation (TA). Methods Frailty and comorbidity were assessed using the modified frailty index of the Canadian Study of Health and Aging (11-CSHA) and the age-adjusted Charlson-Comorbidity Index (aaCCI) as well as albumin and the radiological skeletal-muscle-index (SMI) in a cohort of n = 447 patients with localized renal masses. Renal tumor anatomy was classified according to the RENAL nephrometry system. Regression analyses were performed to assess predictors of surgical outcome of patients undergoing NSS as well as to identify possible influencing factors of patients undergoing alternative therapies (AS/TA). Results Overall 409 patient underwent NSS while 38 received AS or TA. Patients undergoing TA/AS were more likely to be frail or comorbid compared to patients undergoing NSS (aaCCI: p < 0.001, 11-CSHA: p < 0.001). Gender and tumor complexity did not vary between patients of different treatment approach. 11-CSHA and aaCCI were identified as independent predictors of major postoperative complications (11-CSHA ≥ 0.27: OR = 3.6, p = 0.001) and hospital re-admission (aaCCI ≥ 6: OR = 4.93, p = 0.003) in the NSS cohort. No impact was found for albumin levels and SMI. An aaCCI > 6 and/or 11-CSHA ≥ 0.27 (OR = 9.19, p < 0.001), a solitary kidney (OR = 5.43, p = 0.005) and hypoalbuminemia (OR = 4.6, p = 0.009), but not tumor complexity, were decisive factors to undergo AS or TA rather than NSS. Conclusion In patients with localized renal masses, frailty and comorbidity indices can be useful to predict surgical outcome and support decision-making towards AS or TA.

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“…However, studies in other fields have shown that subjective judgments of frailty are poorer predictors compared with objective measures, and they are very poorly reproducible from clinician to clinician. 61 The study of Wohlauer et al 51 of 1089 patients undergoing juxtarenal and thoracoabdominal aneurysm repairs demonstrated that severe hypoalbuminemia (<2.4 g/dL) is predictive of a nearly 5-fold increase in 30-day mortality and a 2.5-fold increase in 2-year mortality. 51 More liberal cutoffs of serum albumin concentration of <3.5 g/dL have been used in most other studies, including patients undergoing cardiac surgery.…”

Section: Prognostic Value Of Frailty In Vascular Surgerymentioning

confidence: 99%

Scoping review of frailty in vascular surgery

Drudi

Ades

Landry

et al. 2019

Journal of Vascular Surgery

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Preoperative Hypoalbuminemia is a Risk Factor for Early and Late Mortality in Patients Undergoing Endovascular Juxtarenal and Thoracoabdominal Aortic Aneurysm Repair

Cited by 15 publications

References 17 publications

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

<p>Frailty In Patients Undergoing Vascular Surgery: A Narrative Review Of Current Evidence</p>

Frailty predicts outcome of partial nephrectomy and guides treatment decision towards active surveillance and tumor ablation

Scoping review of frailty in vascular surgery

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