Hypoalbuminemia Predicts Serious Complications and Extended Length of Stay in Sleeve Gastrectomy Conversions: An MBSAQIP Analysis of 44,368 Cases
Wills M1; Mocanu V1; Kachornvitaya P1; Pasricha A1; Zhu X1; Barajas-Gamboa2; Lee Y1; Rosenthal R3; Dang J1; Corcelles R1; Strong A1; Kroh M1; Navarrete S1
1Cleveland Clinic Foundation; 2Cleveland Clinic Abu Dhabi; 3Cleveland Clinic Florida
Background & Objectives
•Revisional and conversional bariatric procedures are increasingly common
•Hypoalbuminemia reflects malnutrition and systemic inflammation and is associated with adverse surgical outcomes
•The impact of malnutrition following SG conversion remains poorly characterized
•We examined whether preoperative hypoalbuminemia independently predicts serious complications and extended length of stay (LOS) following SG conversion
Methods
•Retrospective analysis of the MBSAQIP database (2020–2023)
•Patients undergoing conversion from SG to RYGB, SADI, or BPD were included
•Hypoalbuminemia defined as preoperative serum albumin ≤3.5 g/dL; extended LOS defined as ≥3 days
•Chi-squared and Wilcoxon rank-sum tests compared patient characteristics and 30-day outcomes; multivariable logistic regression identified independent predictors of serious complications and extended LOS
Key Outcomes
•Of 44,368 SG conversion patients, 3,440 (7.8%) had hypoalbuminemia; these patients had higher BMI, insulin-dependent diabetes, renal insufficiency, and history of VTE (all p<0.001)
•Hypoalbuminemic patients had higher rates of serious complications (8.8% vs 6.3%), readmissions (8.9% vs 6.8%), bleeding (2.2% vs 1.7%), leaks (0.9% vs 0.6%), and extended LOS (1.9 vs 1.6 days) (all p<0.05)
•On multivariable analysis, hypoalbuminemia independently predicts serious complications (OR 1.39; 95% CI 1.22–1.58) and extended LOS (OR 1.52; 95% CI 1.38–1.68)
Conclusions
•Preoperative hypoalbuminemia independently predicts serious complications (OR 1.39) and extended LOS (OR 1.52) following SG conversion
•Despite higher BMI, hypoalbuminemic patients carry greater comorbidity burden, suggesting a phenotype of sarcopenic obesity with underlying malnutrition masked by excess adiposity
•Future studies should evaluate whether preoperative nutritional optimization reduces morbidity in this high-risk revisional surgery population
