Role of Serum Albumin as Predictor of Postoperative Morbidity and Mortality in Gastrointestinal Surgeries
Serum Albumin and Gastrointestinal Surgery
DOI:
https://doi.org/10.54393/pjhs.v5i06.1745Keywords:
Serum Albumin, Gastrointestinal Surgery, Hypoalbuminemia, Surgical Site InfectionsAbstract
Serum albumin, a key protein in human plasma, maintains oncotic pressure and transports various substances. In gastrointestinal surgeries, the impact of low preoperative serum albumin on postoperative morbidity and mortality is significant but not fully understood. Objective: To determine the role of serum albumin levels as a predictor of postoperative morbidity and mortality in patients undergoing gastrointestinal surgeries. Methods: This prospective cohort study was conducted at Department of Surgery – Jinnah Post Graduate Medical Centre, Karachi from January 01, 2021, to December 31, 2021. The study included 86 patients with age range 18 to 45 years and of either gender who had undergone elective gastrointestinal surgeries and had preoperative serum albumin levels measured within 7 days before the surgery. Patients having exploratory laparotomy involving organs other than GIT, those who lost to follow-up and patients with conditions that significantly affect serum albumin levels, such as chronic liver disease or nephrotic syndrome, were excluded from the study. Results: Hypoalbuminemia (<3.5 mg/dL) was observed in 61 patients (70.9%), while 25 patients (29.1%) had normal albumin levels (>3.5 mg/dL). All 30-day mortalities occurred in the hypoalbuminemia group (p < 0.05). Superficial surgical site infections were significantly higher in the hypoalbuminemia group as well (73.4% vs. 26.6%, p < 0.05). Other complications were more frequent in patients with hypoalbuminemia but were not statistically significant (p > 0.05). Conclusions: The study findings indicate that preoperative serum albumin levels were a significant predictor of postoperative complications in patients undergoing elective gastrointestinal surgeries
References
Cohen S, Gal J, Freifeld Y, Khoury S, Dekel Y, Hofman A et al. Nutritional status impairment due to neoadjuvant chemotherapy predicts post-radical cystectomy complications. Nutrients. 2021 Dec; 13(12): 4471. doi: 10.3390/nu13124471. DOI: https://doi.org/10.3390/nu13124471
Kehlet H. Enhanced postoperative recovery: good from afar, but far from good?. Anaesthesia. 2020 Jan; 75: e54-61. doi: 10.1111/anae.14860. DOI: https://doi.org/10.1111/anae.14860
Giglia MD and Stein SL. Overlooked long-term complications of colorectal surgery. Clinics in Colon and Rectal Surgery. 2019 May; 32(03): 204-11. doi: 10.1055/s-0038-1677027. DOI: https://doi.org/10.1055/s-0038-1677027
Rokka R, Lukovich P, Vadinszky P. Colorectal surgery for malignant diseases in elderly patients. Is laparoscopic surgery safe?. European Journal of Surgical Oncology. 2019 Feb; 45(2): e114-5. doi: 10.1016/j.ejso.2018.10.395. DOI: https://doi.org/10.1016/j.ejso.2018.10.395
Mehraj A and Chowdri NA. Colorectal Surgery: Is There a Need to Recognize it as a Separate Super Specialty in India?. Indian Journal of Colo-Rectal Surgery. 2020 Jan; 3(1): 16-22. doi: 10.4103/IJCS.IJCS_27_20. DOI: https://doi.org/10.4103/IJCS.IJCS_27_20
Luchetti TJ, Chung A, Olmscheid N, Bohl DD, Hustedt JW. Hypoalbuminemia is associated with increased postoperative mortality and complications in hand surgery. Hand. 2020 Jul; 15(4): 547-55. doi: 10.1177/1558944718820959. DOI: https://doi.org/10.1177/1558944718820959
Keller U. Nutritional laboratory markers in malnutrition. Journal of Clinical Medicine. 2019 May; 8(6): 775. doi: 10.3390/jcm8060775. DOI: https://doi.org/10.3390/jcm8060775
Portuondo JI, Probstfeld L, Massarweh NN, Le L, Wei Q, Chai CY et al. Malnutrition in elective surgery: How traditional markers might be failing surgeons and patients. Surgery. 2020 Dec; 168(6): 1144-51. doi: 10.1016/j.surg.2020.08.012. DOI: https://doi.org/10.1016/j.surg.2020.08.012
Kang B, Zhao ZQ, Liu XY, Cheng YX, Tao W, Wei ZQ et al. Effect of hypoalbuminemia on short-term outcomes after colorectal cancer surgery: A propensity score matching analysis. Frontiers in Nutrition. 2022 Aug; 9: 925086. doi: 10.3389/fnut.2022.925086. DOI: https://doi.org/10.3389/fnut.2022.925086
Sathianathen NJ, Kwaan M, Lawrentschuk N, Weight CJ, Kim SP, Murphy DG et al. Adverse impact of malnutrition markers on major abdominopelvic cancer surgery. ANZ Journal of Surgery. 2019 May; 89(5): 509-14. doi: 10.1111/ans.15129. DOI: https://doi.org/10.1111/ans.15129
Ionescu D, Tibrea C, Puia C. Pre-operative hypoalbuminemia in colorectal cancer patients undergoing elective surgery-a major risk factor for postoperative outcome. Chirurgia (Bucur). 2013 Nov; 108(6): 822-8.
Bhagvat VM, Ghetla S, Shetty T, Upwanshi M. Role of serum albumin and body mass index as predictors of post-operative morbidity and mortality in elective major abdominal surgeries. International Surgery Journal. 2017 Jan; 4(1): 91-6. doi: 10.18203/2349-2902.isj20163973. DOI: https://doi.org/10.18203/2349-2902.isj20163973
Rao CA and Reddy A. Postoperative Drop in Serum Albumin levels as an Indicator for Surgical stress and Clinical Outcome in Laparotomy Patients: A Prospective Observational Clinical Study. Journal of Chalmeda Anand Rao Institute of Medical Sciences Vol. 2021 Jul; 22(2): 31. doi: 10.1155/2021/8743187.
Kumar S, Prakash DG, Pottendla VK. Preoperative serum albumin level as a predictor of surgical complications after emergency abdominal surgery. International Surgery Journal. 2019 Jan; 6(2): 361-4. doi: 10.18203/2349-2902.isj20190383. DOI: https://doi.org/10.18203/2349-2902.isj20190383
Farrell MR, Tighiouart H, Vanni AJ. Hypoalbuminemia is associated with increased 30-day complications following rectourethral fistula repair: a National Surgical Quality Improvement Program Study. Urology Practice. 2022 Mar; 9(2): 158-65. doi: 10.1097/UPJ.0000000000000286. DOI: https://doi.org/10.1097/UPJ.0000000000000286
Lohsiriwat V, Lohsiriwat D, Boonnuch W, Chinswangwatanakul V, Akaraviputh T, Lert-Akayamanee N. Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World Journal of Gastroenterology. 2008 Feb; 14(8): 1248. doi: 10.3748/wjg.14.1248. DOI: https://doi.org/10.3748/wjg.14.1248
Berbel-Franco D, Lopez-Delgado JC, Putzu A, Esteve F, Torrado H, Farrero E et al. The influence of postoperative albumin levels on the outcome of cardiac surgery. Journal of Cardiothoracic Surgery. 2020 Dec; 15: 1-3. doi: 10.1186/s13019-020-01133-y. DOI: https://doi.org/10.1186/s13019-020-01133-y
Dijkink S, Meier K, Krijnen P, Yeh DD, Velmahos GC, Schipper IB. Malnutrition and its effects in severely injured trauma patients. European Journal of Trauma and Emergency Surgery. 2020 Oct; 46: 993-1004. doi: 10.1007/s00068-020-01304-5. DOI: https://doi.org/10.1007/s00068-020-01304-5
Wang D, Hu X, Xiao L, Long G, Yao L, Wang Z et al. Prognostic nutritional index and systemic immune-inflammation index predict the prognosis of patients with HCC. Journal of Gastrointestinal Surgery. 2021 Feb; 25(2): 421-7. doi: 10.1007/s11605-019-04492-7. DOI: https://doi.org/10.1007/s11605-019-04492-7
Lalhruaizela S, Lalrinpuia B, Gupta D. Serum Albumin is a Predictor for Postoperative Morbidity and Mortality in Gastrointestinal Surgeries. Journal of Clinical & Diagnostic Research. 2020 May; 14(5). doi: 10.7860/JCDR/2020/44315.13682. DOI: https://doi.org/10.7860/JCDR/2020/44315.13682
Kudsk KA, Tolley EA, DeWitt RC, Janu PG, Blackwell AP, Yeary S et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. Journal of Parenteral and Enteral Nutrition. 2003 Jan; 27(1): 1-9. doi: 10.1177/014860710302700101. DOI: https://doi.org/10.1177/014860710302700101
Galata C, Busse L, Birgin E, Weiß C, Hardt J, Reißfelder C et al. Role of albumin as a nutritional and prognostic marker in elective intestinal surgery. Canadian Journal of Gastroenterology and Hepatology. 2020 Apr; 2020(1): 7028216. doi: 10.1155/2020/7028216. DOI: https://doi.org/10.1155/2020/7028216
Roy N. A study to evaluate pre-operative serum albumin as predictor of post-operative morbidity. International Journal of Scientific Research. 2020 Jan; 9(1): 1-8. doi: 10.36106/ijsr. DOI: https://doi.org/10.36106/ijsr
Petch-In P, Saokaew S, Phisalprapa P, Dilokthornsakul P. The association of pre-operative serum albumin levels and post-operative in-hospital death in patients undergoing gastrointestinal surgeries in Thailand: a retrospective cohort study. Drugs-Real World Outcomes. 2023 Jun; 10(2): 341-9. doi: 10.1007/s40801-023-00364-4. DOI: https://doi.org/10.1007/s40801-023-00364-4
Kramer P, Schleiger A, Schafstedde M, Danne F, Nordmeyer J, Berger F et al. A multimodal score accurately classifies Fontan failure and late mortality in adult Fontan patients. Frontiers in Cardiovascular Medicine. 2022 Mar; 9: 767503. doi: 10.3389/fcvm.2022.767503. DOI: https://doi.org/10.3389/fcvm.2022.767503
Akirov A, Gorshtein A, Adler‐Cohen C, Steinmetz T, Shochat T, Shimon I. Low serum albumin levels predict short‐and long‐term mortality risk in patients hospitalised to general surgery wards. Internal Medicine Journal. 2020 Aug; 50(8): 977-84. doi: 10.1111/imj.14708. DOI: https://doi.org/10.1111/imj.14708
Liang WQ, Zhang KC, Li H, Cui JX, Xi HQ, Li JY et al. Preoperative albumin levels predict prolonged postoperative ileus in gastrointestinal surgery. World Journal of Gastroenterology. 2020 Mar; 26(11): 1185. doi: 10.3748/wjg.v26.i11.1185. DOI: https://doi.org/10.3748/wjg.v26.i11.1185
Pradeep Ghimire MS and Samyukta KC. Role of Serum Albumin as Predictor of Postoperative Morbidity and Mortality in Elective Gastrointestinal Surgeries. Archives of Surgery. 1999; 134(1): 36-42. doi: 10.1001/archsurg.134.1.36. DOI: https://doi.org/10.1001/archsurg.134.1.36
Şavluk ÖF, Güzelmeriç F, Yavuz Y, Ukil F, Yılmaz AA, Tan Recep BZ et al. Albumin, Globulin and Albumin-Globulin Ratio ID as a Predictor of Mortality, Morbidity After Fontan Operations. Journal of the Society of Thoracic Carido-Vascular Anaesthesia & Intensive Care. 2019 Sep; 25(3). doi: 10.5222/GKDAD.2019.20633. DOI: https://doi.org/10.5222/GKDAD.2019.20633
Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Annals of surgery. 2010 Aug; 252(2): 325-9. doi: 10.1097/SLA.0b013e3181e9819a. DOI: https://doi.org/10.1097/SLA.0b013e3181e9819a
Udeh CI, You J, Wanek MR, Dalton J, Udeh BL, Demirjian S et al. Acute kidney injury in postoperative shock: is hyperoncotic albumin administration an unrecognized resuscitation risk factor?. Perioperative Medicine. 2018 Dec; 7: 1-1. doi: 10.1186/s13741-018-0110-y. DOI: https://doi.org/10.1186/s13741-018-0110-y
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