Association between perioperative prealbumin level and outcomes in coronary bypass surgery patients.

Abstract

Background: Albumin and BMI have been used as nutritional markers of morbidity and mortality. Recently, prealbumin has grown in interest in other surgical disciplines, but less so in cardiac surgery. Thus, this study examined the association between prealbumin and bleeding, mortality, and readmission in coronary artery bypass graft (CABG) patients.

Methods: A retrospective review was performed on all patients undergoing CABG at a single institution from July 2017 to December 2021. Study patients underwent CABG as part of an isolated or combined procedure and had a perioperative prealbumin measurement. The primary study endpoints were intra- and post-operative bleeding, and mortality and hospital readmission within 30 days.

Results: A total of 1211 patients underwent CABG surgery and had a documented perioperative prealbumin. Prealbumin levels were stratified as ≤10, 10-15, 15-20, or >20 mg/dl. There were no differences across prealbumin groups in preoperative antiplatelet use, anticoagulant use, or concomitant procedures. Patients with low prealbumin were more likely to be older, female, and to have an urgent myocardial infarction presentation with lower preoperative BMI and albumin. In adjusted models including albumin and BMI, CABG patients with prealbumin ≤10 mg/dl were more likely to receive any intraoperative [odds ratio (OR) = 3.11, 95% confidence interval (CI): 1.43, 6.75] or postoperative transfusion (OR = 2.54, 95% CI: 1.27, 5.08) compared to patients with prealbumin >20 mg/dl. Patients with a lower prealbumin had higher 30-day mortality (P < 0.001) and readmission rates (P = 0.06).

Conclusion: Perioperative prealbumin levels were associated with blood transfusions, mortality, and readmissions in CABG patients.