Outcomes After Carotid Artery Stenting in Patients With Normal Neck Anatomy and Hostile Neck Anatomy Are Comparable

Abstract

Objective: There are limited data evaluating the impact of preoperative albumin levels in patients undergoing vascular procedures. This study evaluated the relationship of preoperative albumin levels with outcome after lower extremity (LE) vascular procedures for peripheral artery disease (PAD). Methods: Patients with PAD admitted for elective LE procedures between September 2008 and December 2015 were selected from the Cerner Health Facts database using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes and preoperative laboratory values. Multivariable logistic regression was used to examine the association of patient characteristics, procedure type, and low preoperative albumin levels (<3.5 g/dL) with seven critical postoperative outcomes. Results: Of 4087 patients who underwent LE procedures for PAD, 1288 (31.5%) had preoperative albumin levels <3.5 g/dL. Lower albumin levels were associated with older patients, female patients, those with tissue loss, and black patients (P < .05). On average, compared with patients with normal preoperative albumin levels ($3.5 g/dL), patients with low preoperative albumin levels experienced longer hospital stays (6.1 vs 2.4 days; P < .0001); higher rates of postprocedure infection (24.5% vs 5.6%; P < .0001), in-hospital mortality (2.5% vs 0.3%; P < .0001), and 30day readmission (15.5% vs 13.1%; P ¼ .04); and more acute problems and complications. Multivariable logistic regression found that patients with low preoperative albumin levels were 2.6 times as likely to have an infectious complication (odds ratio [OR], 2.64; 95% confidence interval [CI], 2.10-3.32), 5.2 times as likely to die in the hospital (OR, 5.16; 95% CI, 2.34-11.39), and 2.4 times as likely to experience renal failure (OR, 2.47; 95% CI, 1.77-3.46) and cardiac complications (OR, 2.43; 95% CI, 1.66-3.57). Conclusions: LE procedures are performed for a variety of indications; the majority of these are not related to critical limb ischemia and are elective. In patients with low preoperative albumin levels, we strongly recommend deferring elective LE procedures for PAD, given the association with death and severe complications postoperatively. If LE procedures are necessary because of the severity of PAD, the role of preoperative nutritional optimization should be considered before intervention.