03.17 Impact of Malnutrition on Outcomes Following Groin Hernia Repair: Insights from the ACS-NSQIP

R. Mabeza1, C. Pan1, J. Hadaya1, M. Park1, C. Lee1, I. MacQueen1, P. Benharash1  1David Geffen School Of Medicine, University Of California At Los Angeles, Los Angeles, CA, USA

Introduction: Malnutrition has been associated with increased mortality and morbidity following various surgical procedures. However, its impact on outcomes following groin hernia repair has yet to be studied in a contemporary, national cohort. The present study aimed to assess the association of malnutrition with postoperative outcomes and resource use following groin hernia repair.

Methods: Adults (≥ 18 years) undergoing inguinal or femoral hernia repair (open and laparoscopic) were identified using the 2006-2019 American College of Surgeons National Surgical Quality Improvement Program Database. Patients with no recorded preoperative serum albumin were excluded. Malnutrition was defined as a preoperative albumin level < 3.5 g/dL. Multivariable regression models were developed to assess the association of malnutrition with outcomes of interest including 30-day mortality, complications (infectious, respiratory, and thrombotic), reoperation, postoperative length of stay (LOS), and readmission.

Results: Of the 106,555 patients meeting inclusion criteria, 8,002 (7.5%) were malnourished. Compared to others, malnourished patients were older (54.1 vs. 48.0 years, p<0.001), more commonly female (11.7% vs. 9.3%, p<0.001), and more frequently underwent an emergency (12.7% vs. 2.5%, p<0.001) or open procedure (82.5% vs. 66.6%, p<0.001). After risk adjustment, malnutrition was associated with greater odds of 30-day mortality (AOR 2.94, 95% CI: 2.30-3.77), infectious (AOR 1.71, 95% CI: 1.46-2.01), respiratory (AOR 2.07, 95% CI: 1.55-2.76), and thrombotic complications (AOR 1.72, 95% CI: 1.18-2.52). Additionally, malnutrition was associated with greater odds of readmission (AOR 1.79, 95% CI: 1.58-2.03) and increased LOS (β: +0.4 day, 95% CI: 0.3-0.4). Decreasing serum albumin levels were associated with increased probability of mortality for both open and laparoscopic hernia repairs, with significantly increased mortality at an albumin ≤ 3.5 (Figure).

Conclusion: Decreased preoperative serum albumin is associated with increased mortality and morbidity following open and laparoscopic groin hernia repair. Serum albumin remains a relevant predictor of postsurgical outcomes and can thus be used in counseling and shared decision making with malnourished patients in need of groin hernia repair.