Background

Hypoalbuminemia (HA) is a risk factor for serious complications after elective bariatric surgery. Patients undergoing revisional/conversional bariatric surgery may represent a higher-risk group of patients who often have underlying comorbid medical illnesses and are undergoing more complex surgery. Our primary aim investigated postoperative complications in patients with HA undergoing revisional/conversional surgery using a national database.

Methods

The MBSAQIP database was used to evaluate patients undergoing non-banding revisional/conversional bariatric surgery between 2015 and 2019. Patients were categorized by serum albumin (£ 3.5 g/dL). Variables were assessed via bivariate analysis and multivariable regression. Additionally, propensity score matching sub analysis was conducted to compare gastric bypass to sleeve gastrectomy.

Results

147,430 patients underwent revisional/conversional procedures. After applied exclusions there were 58,777 patients available for analysis. The HA group had a significantly (p<0.05) higher incidence of being black (22.95% vs 17.76%), renal insufficiency (1.08% vs 0.36%), smoking within 12 months of surgery (9.47% vs 6.91%), COPD (2.54% vs 1.33%), and history of DVT (4.03% vs 2.3%). Post-operative complications associated with HA included perioperative blood transfusion (3.1% vs 1.27%; p<0.0001), thirty-day readmission (10.87 vs 6.77%; p<0.0001), thirty-day reoperation (4.9% vs 3.18%; p<0.0001), and thirty-day mortality (0.40% vs 0.14%; p<0.0001). HA was a significant predictor of thirty-day readmission in the RYGB vs sleeve matched cohort (OR 1.30; 95% CI [1.14,1.48], p<0.001).

Conclusions

Hypoalbuminemia is a risk factor requiring attention for patients undergoing revisional/conversional bariatric surgery and optimization of nutritional status or medical comorbidities associated with HA prior to bariatric surgery may help avoid post-operative complications.