J. Miranda1, H. Younes1, L. Le1, L. Probstfeld2, J. Braun1, N. Barshes1, P. Kougias1, H. S. Tran Cao1 1Baylor College Of Medicine,Surgery,Houston, TX, USA 2Michael E. DeBakey Veterans Affairs Medical Center,Nutrition,Houston, TX, USA
Introduction: Malnutrition is a known risk factor for poor wound healing and surgical wound infections, especially important clinical outcomes for vascular surgery patients. In 2012, leading dietetic organizations issued a consensus definition of clinical malnutrition based on 6 clinical parameters (AND/ASPEN criteria). We sought to assess the incidence of malnutrition for vascular surgery patients using this definition compared to serologic markers commonly used as indicators.
Methods: This is a retrospective cohort study of patients undergoing elective vascular surgical procedures at a single institution (2015-2017) who received malnutritional screening via a comprehensive nutritional program that included AND/ASPEN criteria. These criteria include weight loss, decreased oral intake, muscle mass loss, loss of subcutaneous fat, fluid accumulation, and decreased hand grip strength. Per AND/ASPEN guidelines, at least two deficits must be met to establish a diagnosis of malnutrition. Correlation with serologic markers was measured.
Results: Among 65 patients admitted for elective vascular procedures who received a comprehensive nutritional screening by a trained dietitian, 16 (24.6%) did not meet criteria for malnutrition, 21 (32.3%) were moderately malnourished, 11 (16.9%) were severely malnourished, and 17 (26.2%) were not fully assessed due to missing anthropometric data or key elements of the history and physical examination. Although serum albumin was higher among non-malnourished patients than moderately and severely malnourished patients (3.12 ± 0.64 vs. 3.04 ± 0.51 vs. 2.71 ± 0.68, respectively, p=0.202), this difference failed to reach significance. Moreover, 10/21 (47.6%) of moderately and 3/11 (27.3%) of severely malnourished patients had serum albumin > 3.0 g/dL, a cut-off often used to represent malnutrition. Serum prealbumin was not routinely obtained, but was likewise non-discriminatory in detecting clinical malnutrition (e.g. exceeding 18 mg/dL in malnourished patients by AND/ASPEN criteria). In turn, no surgical site infection was encountered in the clinically non-malnourished cohort, compared to 3 detected in clinically malnourished patients, including one without hypoalbuminemia.
Conclusion: The prevalence of clinical malnutrition is significant among vascular surgery patients, and may not be fully appreciated with serologic markers alone. As malnutrition may be a modifiable preoperative risk factor, efforts to comprehensively screen for this condition relying on a combination of clinical and serologic markers may be beneficial.