Association Between a Female Low-BMI and Hypoalbuminemic Phenotype and Intraoperative Hemodynamic and Metabolic Outcomes: A Retrospective Analysis of the VitalDB Dataset

Résumé fourni par la source

This study is a retrospective observational analysis using the publicly available VitalDB dataset to evaluate whether a female low-body-mass and hypoalbuminemic phenotype is associated with adverse intraoperative hemodynamic and metabolic outcomes. The primary exposure is an operationally defined FUS-like phenotype, defined as female sex, body mass index <18.5 kg/m², and preoperative serum albumin <3.5 g/dL. This phenotype was selected to capture a subgroup of female patients with low body mass and biochemical evidence of nutritional vulnerability using variables available in the VitalDB dataset. The primary outcome is intraoperative hypotension burden, defined as the cumulative duration of mean arterial pressure <65 mmHg. Secondary outcomes include additional hypotension measures, invasive arterial pressure–based hypotension outcomes, oxygenation and ventilation parameters, anesthetic exposure variables, bispectral index–based anesthetic depth, metabolic laboratory outcomes such as maximum lactate and minimum pH, and urine output normalized to anesthesia duration. The purpose of this study is to determine whether the FUS-like phenotype is associated with greater intraoperative hypotension burden and worse metabolic stress markers after accounting for key clinical covariates. The main regression models will adjust for age, American Society of Anesthesiologists physical status, emergency surgery, and operation duration. Sensitivity analyses will evaluate alternative exposure definitions, including female sex with low BMI alone, female sex with hypoalbuminemia alone, and a severe phenotype incorporating preoperative anemia. The expected outcome of this project is to clarify whether a readily identifiable preoperative phenotype characterized by female sex, low BMI, and hypoalbuminemia is associated with clinically relevant intraoperative instability. Because this study uses an existing public dataset and preliminary data processing and exploratory analyses have already been performed, this registration is intended to archive the statistical analysis plan for transparency before final manuscript submission rather than to serve as a fully prospective preregistration.

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