The impact of hypoalbuminemia on postoperative outcomes after outpatient surgery: a national analysis of the NSQIP database

Curran, Sean; Apruzzese, Patricia; Kendall, Mark C.; Oliveira, Gildasio De

doi:10.1007/s12630-022-02280-7

Cited by 11 publications

(7 citation statements)

References 31 publications

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“…On further analysis, we demonstrated that while increases in serum albumin concentration are generally associated with decreased rates of adverse surgical events among patients with hypoalbuminemia and normal serum albumin, the effect is more pronounced among patients with serum albumin concentration near the low end of normal range (3.4–4.4 g/dL) and is not consistently observed among patients with serum albumin concentration in the high normal range (>4.4 g/dL). A similar finding has been reported previously among a cohort of outpatient surgery patients derived from NSQIP [ 24 ]. This trend in the spline curve was observed among composite primary outcomes and death even after controlling for covariates that are highly associated with alterations in albumin concentration such as age and disseminated cancer as well as controlling for factors that directly alter odds of adverse events such as surgical specialty.…”

Section: Discussionsupporting

confidence: 90%

The Association between Serum Albumin and Post-Operative Outcomes among Patients Undergoing Common Surgical Procedures: An Analysis of a Multi-Specialty Surgical Cohort from the National Surgical Quality Improvement Program (NSQIP)

Nipper

Lim

Riveros

et al. 2022

JCM

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While studies have demonstrated an association between preoperative hypoalbuminemia and adverse clinical outcomes, the optimal serum albumin threshold for risk-stratification in the broader surgical population remains poorly defined. We sought define the optimal threshold of preoperative serum albumin concentration for risk-stratification of adverse post-operative outcomes. Using the American College of Surgeons National Surgical Quality Improvement Program Database, we identified 842,672 patients that had undergone a common surgical procedure in one of eight surgical specialties. An optimal serum albumin concentration threshold for risk-stratification was determined using receiver-operating characteristic analysis. Multivariable logistic regression analysis was used to evaluate the odds of adverse surgical events; a priori defined subgroup analyses were performed. A serum albumin threshold of 3.4 g/dL optimally predicted adverse surgical outcomes in the broader cohort. After multivariable analysis, patients with hypoalbuminemia had increased odds of death within 30 days of surgery (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.94–2.08). Hypoalbuminemia was associated with greater odds of primary adverse events among patients with disseminated cancer (OR 2.03, 95% CI 1.88–2.20) compared to patients without disseminated cancer (OR 1.47, 95% CI 1.44–1.51). The standard clinical threshold for hypoalbuminemia is the optimal threshold for preoperative risk assessment.

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Section: Discussionsupporting

confidence: 90%

The Association between Serum Albumin and Post-Operative Outcomes among Patients Undergoing Common Surgical Procedures: An Analysis of a Multi-Specialty Surgical Cohort from the National Surgical Quality Improvement Program (NSQIP)

Nipper

Lim

Riveros

et al. 2022

JCM

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“…Other variables that our study found to increase HR after IBR but not AR include anemia and hypoalbuminemia. While hypoalbuminemia has been associated with major post-surgical complications, it is considered a metric for malnutrition; therefore, it is surprising that malnutrition increased risk for HR after AR, whereas hypoalbuminemia increased risk for IBR 27) . As hypoalbuminemia is only one component of overall malnutrition, it is possible that this difference suggests a more important role for comprehensive nutrition in the immediate postoperative period after AR, whereas albumin itself may be a key factor in healing after IBR, perhaps in part due to its role in maintaining oncotic pressure.…”

Section: Discussionmentioning

confidence: 99%

Predictors of 30-day Hospital Readmission after Autologous vs. Implant-based Breast Reconstruction: A 16-year Analysis of 175,474 Patients

L. Lipkin,

Li,

G. Ranganath

2024

JPRS

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Objectives: Comorbidities that impair wound healing, increase infection risk, and compromise tissue viability influence rates of hospital readmission after autologous reconstruction and implant-based reconstruction. This study aimed to evaluate patient factors that increase risk for 30-day hospital readmission after autologous reconstruction and implant-based reconstruction and identify differences in the comorbidities that affect readmission risk after each method. Methods: Patients from 2005 to 2021 were selected by autologous reconstruction and implant-based reconstruction current procedural terminology codes from the American College of Surgeons National Surgical Quality Improvement Program database. A multivariable regression model identified the significant predictors of unplanned readmission. Results: Comorbidities that increase risk for readmission after autologous reconstruction but not implant-based reconstruction include dialysis (OR 3.87, p = 0.042) and malnutrition (OR 3.20, p = 0.003). Risk factors for readmission after implant-based reconstruction but not autologous reconstruction include bleeding disorder (OR 2.62, p < 0.0001), previous infection (OR 1.49, p = 0.045), recent sepsis (OR 2.16 p = 0.0003), anemia (OR 1.13, p = 0.0018), and hypoalbuminemia (OR 1.35, p = 0.0213). Predictors of unplanned readmission after both methods include chronic obstructive pulmonary disorder, obesity, inpatient status prior to procedure, Black or White race, chronic steroid use, smoking, diabetes, and hypertension. Conclusions: These findings may be used to individualize preoperative discussions and help guide optimization of risk factors. In addition, while autologous reconstruction and implant-based reconstruction are often combined into one category for discussion of factors that increase complication risk, our study suggests that the types of reconstruction differ with regard to the comorbidities that increase risk for hospital readmission.

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“…Hypoalbuminemia, a sign of malnutrition, has been found to predict postoperative complications, longer hospital stays, and mortality after hip fracture repair [20]. It is also associated with postoperative complications and mortality after outpatient surgery [21]. In a related study on total shoulder arthroplasty, Mehta et al [22] found that patients undergoing outpatient procedures were less likely to have hypoalbuminemia, further supporting this association.…”

Section: A a B Bmentioning

confidence: 96%

Inpatient or outpatient total elbow arthroplasty: a comparison of patient populations and 30-day surgical outcomes from the American College of Surgeons National Surgical Quality Improvement Program

Momtaz,

Ahmad,

Singh

et al. 2023

Clin Shoulder Elb

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Background: Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting.Methods: Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days.Results: A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037).Conclusions: Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery.Level of evidence: III.

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The impact of hypoalbuminemia on postoperative outcomes after outpatient surgery: a national analysis of the NSQIP database

Cited by 11 publications

References 31 publications

The Association between Serum Albumin and Post-Operative Outcomes among Patients Undergoing Common Surgical Procedures: An Analysis of a Multi-Specialty Surgical Cohort from the National Surgical Quality Improvement Program (NSQIP)

The Association between Serum Albumin and Post-Operative Outcomes among Patients Undergoing Common Surgical Procedures: An Analysis of a Multi-Specialty Surgical Cohort from the National Surgical Quality Improvement Program (NSQIP)

Predictors of 30-day Hospital Readmission after Autologous vs. Implant-based Breast Reconstruction: A 16-year Analysis of 175,474 Patients

Inpatient or outpatient total elbow arthroplasty: a comparison of patient populations and 30-day surgical outcomes from the American College of Surgeons National Surgical Quality Improvement Program

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