The Prognostic Role of Preoperative Nutrition Status in Patients Undergoing Interventions for Peripheral Artery Disease

Abstract

Patients with peripheral arterial disease (PAD) are often comorbid and frail. Although several validated nutrition scales exist, the role of preoperative nutrition status in these patients is not well characterized, nor is it routinely implemented as part of the preoperative vascular care in current clinical practice. This scoping review sought to describe the prevalence and prognostic implications of preoperative nutrition status in patients undergoing vascular interventions for claudication and critical limb-threatening ischemia. Studies were systematically searched across six databases from inception to November 2021. Studies focusing on patients with claudication or critical limb-threatening ischemia undergoing open, endovascular, or hybrid procedures were included if preoperative nutrition status was measured and associated with a clinical outcome. Two independent reviewers selected studies for inclusion, extracted data, and assessed risk of bias using ROBINS-I and Newcastle-Ottawa scales. Extracted data included study characteristics, demographics and clinical characteristics, nutritional tool used, preoperative nutritional status, interventions performed, outcome measured, and association of nutritional status on outcomes. Twenty-four studies addressed the prevalence or prognostic impact of malnutrition in patients undergoing interventions for PAD. The prevalence of preoperative malnutrition ranged from 14.6% to 72%, and notably seven different malnutrition assessments were used in these studies. Across all scales, preoperative malnutrition was associated with at least one of the following outcomes: increased mortality, major adverse limb events, postoperative complications, length of stay, readmission, and poor wound healing. There are a variety of heterogeneous tools to measure malnutrition in patients undergoing interventions for PAD. The prevalence of malnutrition varies by the scale used to measure it, as does its predictive value. Our qualitative findings suggest that preoperative malnutrition is associated with adverse clinical outcomes in this population. Clinicians and surgeons should therefore be sensitized to the importance of assessing preoperative malnutrition and view it as a preoperative target for patient optimization and decision-making in adults undergoing interventions for PAD.