Preoperative albumin and surgical site identify surgical risk for major postoperative complications

Kudsk, Kenneth A.; Tolley, Elizabeth A.; Dewitt, R. Chance; Janu, Peter; Blackwell, Ashley P.; Yeary, S; King, Brock K.

doi:10.1177/014860710302700101

Cited by 296 publications

(185 citation statements)

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“…Therefore, we believe this represents a random sampling rather than sampling error [12]. Furthermore, albumin may be critiqued as a marker of nourishment, although as a serum marker, it has been used as a surrogate for nutritional status [21]. Although not all patients with low serum albumin may be malnourished, the data show an association between multiple major perioperative complications and low serum albumin.…”

Section: Discussionmentioning

confidence: 99%

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

134

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Background Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications after TKA. However, morbid obesity and malnutrition often are co-occurring conditions. Therefore it is important to understand whether morbid obesity, malnutrition, or both are independently associated with more frequent perioperative complications. In addition, assessing the magnitude of an increase in complications and whether these complications are major or minor is important for both conditions. Questions/purposes We asked: (1) Is morbid obesity independently associated with more frequent major perioperative complications after TKA? (2) Are major perioperative complications after TKA more prevalent among patients with a low serum albumin? Methods The National Surgical Quality Improvement Program (NSQIP) database was analyzed from 2006 to 2013. Patients were grouped as morbidly obese (BMI C 40 kg/m 2 ) or nonmorbidly obese (BMI C 18.5 kg/m 2 to \ 40 kg/m 2 ), or by low serum albumin (serum albumin level \ 3.5 mg/dL) or normal serum albumin (serum albumin level C 3.5 mg/dL). The study cohort included 77,785 patients, including 35,573 patients with a serum albumin level of 3.5 g/dL or greater and 1570 patients with a serum albumin level less than 3.5 g/dL. Therefore, serum albumin levels were available for only 37,173 of the 77,785 of the patients (48%). There were 66,382 patients with a BMI between 18.5 kg/m 2 and 40 kg/m 2 and 11,403 patients with a BMI greater than 40 kg/m 2 . Data were recorded on patient mortality along with 21 complications reported in the NSQIP. We also developed three composite complication variables to represent risk of any infections, cardiac or pulmonary complications, and any major complications. For each complication, multivariate logistic regression analysis was performed. Independent variables included patient age, sex, race, BMI, American Society of Anesthesiologists classification, year of surgery, and Charlson comorbidity index score. Results Mortality was not increased in the morbidly obese group (0.14% vs 0.14%; p = 0.942). Patients who were morbidly obese were more likely to have progressive renal insufficiency (0.30% vs 0.10%; odds ratio [OR], 2.47; 95% CI, 1.27-4.29; p \ 0.001), superficial infection (1.07% vs 0.55%; OR, 1.87; 95% CI, 1.39-2.51; p \ 0.001), and sepsis (0.36% vs 0.23%; OR, 1.70; 95% CI, 1.04-2.53; p = 0.034) compared with patients who were not morbidly obese. Patients who were morbidly obese were less likely to require blood transfusion (8.68% vs One of the authors certifies that he (CLN), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Zimmer Inc (Warsaw, IN, USA 12.06%; OR, 0.70; 95% CI, 0.63-0.77; p \ 0.001) compared with patients who were not morbidly obese. Morbid obesity was not associated with any of the other 21 perioperative complications recorded in the NSQIP database. With respect to the composite complication variable...

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Section: Discussionmentioning

confidence: 99%

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

134

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“…Preoperative albumin level is recognized as the best predictor of postoperative morbidity and mortality in various kinds of operations [40][41][42][43]. Prealbumin, also known as transthyretin, is a rapid-turnover protein that could provide a sensitive indicator of nutritional status [44,45].…”

Section: Discussionmentioning

confidence: 99%

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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Background The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications. Methods The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed. Results The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien-Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200; 95 % CI, 1.706-15.850), Roux-en-Y reconstruction (odds ratio, 3.611; 95 % CI, 1.103-11.817), and simultaneous cholecystectomy (odds ratio, 5.008; 95 % CI, 1.378-18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients. Conclusion The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (\4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients.

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“…Serum albumin is a good and simple predictor of surgical risk and has a close correlation with the degree of malnutrition [4] . Hypoalbuminemia is a predictor of delayed recovery of bowel function and is strongly associated with postoperative complications after right hemicolectomy for right-sided colon cancer [5] , or following other major gastrointestinal surgery [6][7][8] . However, there is little information regarding the effect of hypoalbuminemia on the development of postoperative complications after rectal cancer surgery, and the results remain controversial [9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

Lohsiriwat¹,

Lohsiriwat²,

Boonnuch³

et al. 2008

WJG

119

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AIM:To determine the relationship between preoperative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS:The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS:The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m 2 ; P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION:Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.

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Preoperative albumin and surgical site identify surgical risk for major postoperative complications

Cited by 296 publications

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Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

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