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
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),
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
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.