Original article|Articles in Press

Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis

Published:December 09, 2022DOI:


      • Patients with hypoalbuminemia (HA) experience higher rates of severe complications.
      • The readmission rate (10.87%) in patients with HA was exceptionally high.
      • Patients with HA are at increased risk of anastomotic and bleeding complications.
      • Death frequency was higher in patients with HA versus no HA (.40% versus .14%).



      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 who often have underlying co-morbid medical illnesses and more complex surgery.


      This study investigated the postoperative complications in patients with HA undergoing revisional/conversional bariatric surgery.


      Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), years 2015–2019.


      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. Propensity score matching was conducted to compare gastric bypass (RYGB) to sleeve gastrectomy (VSG).


      One hundred forty-seven thousand four hundred thirty patients underwent revisional/conversional procedures. After applied exclusions, 58,777 patients were available for analysis. The HA group had a significantly (P < .05) higher prevalence of being black (22.95% versus 17.76%), renal insufficiency (1.08% versus .36%), smoking history (9.47% versus 6.91%), chronic obstructive pulmonary disease (COPD) (2.54% versus 1.33%), and history of deep vein thrombosis (DVT) (4.03% versus 2.3%). Postoperative complications associated with HA included perioperative blood transfusion (3.1% versus 1.27%; P < .001), 30day readmission (10.87 versus 6.77%; P < .001), 30day reoperation (4.9% versus 3.18%; P < .001), and 30day mortality (.40% versus .14%; P < .0001). HA was a significant predictor of 30day readmission in the RYGB versus VSG matched cohort (odds ratio [OR], 1.30; 95% confidence interval [CI], [1.14, 1.48]; P < .001).


      HA 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 postoperative complications.

      Graphical abstract


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      • Comment on: Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis
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          It has been known for a while that malnutrition, similar to frailty, is a preoperative risk factor for infections, anastomotic failures, and all sorts of complications. I used to say to our residents and fellows that when a bariatric patient comes in with severe malnutrition after a complicated primary bariatric operation (like a stricture after sleeve or gastric bypass) or severe hypo-absorption after duodenal switch, we have to nutritionally replenish these patients until normal parameters are reached before attempting a revision or conversion; this is common sense.
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