Preoperative nutritional status and its association with adverse events following open abdominal aortic aneurysm repair

Introduction: Abdominal aortic aneurysms (AAA) are a potentially fatal vascular condition defined by an aortic diameter exceeding 3.0 cm or demonstrating a ≥50% increase in the normal diameter. This study aims to evaluate the impact of preoperative nutritional status on rupture at presentation and early postoperative complications. Methods: This retrospective, monocentric, observational study included 125 AAA patients admitted for open surgical repair (OSR). Demographic data, comorbidities, and risk factors were obtained from the hospital's electronic database. Nutritional status was quantified using albumin, total protein, Prognostic Nutritional Index (PNI), and CONUT Score. Primary outcomes were postoperative AKI and 30-day mortality. ROC curve analysis showed that albumin, total protein, and PNI had strong correlations with rupture and 30-day mortality, with AUC values of approximately 0.82-0.98, whereas CONUT Score demonstrated a moderate association. In multivariate analyses, lower albumin, serum total protein, and PNI remained independently associated with rupture and 30-day mortality. Meanwhile, a higher CONUT Score remained independently associated with rupture but not with 30-day mortality after full adjustment. Conclusion: Poor preoperative nutritional status is strongly associated with aneurysm rupture at presentation and increased 30-day mortality after OSR. However, in ruptured cases, these biomarkers may reflect acute hemorrhage and physiological stress rather than baseline nutritional status alone.