Preoperative Nutritional Status and Its Association with Adverse Events Following Open Abdominal Aortic Aneurysm Repair

Why It Matters

Identifying malnutrition early enables surgeons to better predict which AAA patients face the highest operative risk, potentially guiding pre‑habitation or alternative treatment strategies. Incorporating inexpensive lab markers into standard pre‑operative work‑ups could reduce mortality in a high‑risk surgical population.

Key Takeaways

• Low albumin linked to 30‑day mortality after open AAA repair
• Higher CONUT score predicts rupture at presentation
• PNI below threshold doubles risk of death
• Ruptured AAA patients comprised 56% of cohort
• Post‑op AKI occurred in 20% of cases

Pulse Analysis

Nutritional status has emerged as a pivotal component of surgical risk assessment, especially in vascular procedures where physiological reserve dictates outcomes. While open abdominal aortic aneurysm repair (OSR) remains the gold standard for younger or anatomically complex patients, its morbidity profile is starkly higher than endovascular approaches. Traditional risk models focus on age, comorbidities, and aneurysm size, yet they often overlook the subtle yet powerful influence of protein‑energy malnutrition, sarcopenia, and systemic inflammation. Laboratory markers such as serum albumin, total protein, and the Prognostic Nutritional Index (PNI) provide a rapid, cost‑effective snapshot of a patient’s nutritional reserve, making them attractive tools for pre‑operative triage.

The Romanian cohort analyzed 125 OSR patients between 2019 and 2024, revealing that low albumin, total protein, and PNI were each independently associated with both aneurysm rupture at admission and 30‑day mortality, with receiver‑operating‑characteristic curves yielding area‑under‑the‑curve values up to 0.98. In contrast, the CONUT score, which incorporates cholesterol and lymphocyte counts, predicted rupture but lost significance for mortality after multivariate adjustment. Notably, none of these biomarkers correlated with postoperative acute kidney injury, suggesting that renal complications may be driven more by intra‑operative hemodynamics than baseline nutrition. These findings reinforce the concept that malnutrition amplifies vulnerability to catastrophic events like rupture and limits the body’s ability to recover from major surgery.

For clinicians, the practical implication is clear: integrating albumin, total protein, and PNI into pre‑operative checklists could sharpen risk stratification, prompting targeted interventions such as nutritional supplementation, pre‑habilitation, or even reconsideration of the operative approach. However, the study’s retrospective, single‑center design and focus solely on OSR limit generalizability. Prospective, multicenter trials that compare these markers across both open and endovascular repairs, and that incorporate functional assessments like grip strength or CT‑derived muscle mass, are needed to validate their predictive power. Until then, surgeons should interpret low nutritional scores in ruptured cases with caution, recognizing that acute hemorrhagic stress may transiently depress these values.