5 - Stratifying Risk of 30-Day Sepsis After Lower Extremity Arterial Interventions Based on Preoperative Albumin Levels

Postoperative sepsis remains a significant challenge in interventional radiology, with preoperative albumin levels potentially serving as a predictor of sepsis risk. However, the optimal preoperative albumin level for lower extremity arterial interventions remains unknown. Therefore, the purpose of this study was (1) to determine the relationship between preoperative albumin levels and 30-day major postoperative complications and sepsis following lower extremity arterial interventions and (2) to establish preoperative albumin thresholds to stratify the risk of 30-day major complications and sepsis following lower extremity arterial interventions.

Materials and Methods:

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was utilized to conduct a retrospective cohort analysis of patients undergoing lower extremity arterial interventions from 2005 to 2019. Stratum-specific likelihood ratio (SSLR) analysis was employed to define preoperative albumin strata associated with varying risk of 30-day complications. Patient demographics and clinical comorbidities were compared using chi-squared analysis and student t-tests, where appropriate, for each stratum against the highest albumin strata. Multivariable regression analysis was conducted for each strata against the highest albumin strata for 30-day all-cause, major, minor, and septic complications.

Results:

SSLR analysis identified four preoperative albumin strata: 1-2.3g/dL, 2.4-3g/dL, 3.1-4.2g/dL, and 4.3+ g/dL. Compared to the 4.3+g/dL cohort, the 1-2.3g/dL (OR: 5.46), 2.4-3g/dL (OR: 3.32), and 3.1-4.2g/dL (OR: 1.82) cohorts had significantly higher odds of 30-day all-cause complications following lower extremity arterial interventions (P < 0.05 for all). Moreover, compared to the 4.3+g/dL cohort, the 1-2.3g/dL (OR: 6.29), 2.4-3g/dL (OR: 3.79), and 3.1-4.2g/dL (OR: 1.87) cohorts had significantly higher odds of 30-day sepsis complications following lower extremity arterial interventions (P < 0.05 for all).

Conclusion: This study established data-driven preoperative albumin thresholds that correlate with an increased risk of 30-day all-cause, major, minor, and septic complications following lower extremity arterial interventions. To the best of our knowledge, this is the first study to demonstrate the variable and stratifiable risk of complications on the basis of preoperative albumin levels. These findings assist interventionalists in stratifying patient risk based on preoperative albumin levels, potentially improving patient outcomes.