Preoperative Serum Albumin Level as a Predictor of Operative Mortality and Morbidity

Abstract

To improve the precision and reliability of estimates of the association between preoperative serum albumin concentration and surgical outcomes.Design: Prospective observational study. Patients were followed up for 30 days postoperatively. Multiple logistic regression models were developed to evaluate serum albumin level as a predictor of operative mortality and morbidity in relation to 61 other preoperative patient risk variables.Setting: Forty-four tertiary care Veterans Affairs (VA) medical centers.Patients: A total of 54 215 major noncardiac surgery cases from the National VA Surgical Risk Study.Main Outcome Measures: Thirty-day operative mortality and morbidity.Results: A decrease in serum albumin from concentrations greater than 46 g/L to less than 21 g/L was associated with an exponential increase in mortality rates from less than 1% to 29% and in morbidity rates from 10% to 65%. In the regression models, albumin level was the strongest predictor of mortality and morbidity for surgery as a whole and within several subspecialties selected for further analysis. Albumin level was a better predictor of some types of morbidity, particularly sepsis and major infections, than other types.Conclusions: Serum albumin concentration is a better predictor of surgical outcomes than many other preoperative patient characteristics. It is a relatively low-cost test that should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes, particularly in populations in whom comorbid conditions are relatively frequent.

Risk factors for pressure ulceration in a resource constrained spinal injury service

“…That this relatively simple and affordable test is underutilized has also been highlighted by previous studies among in-hospital patients. 3,6,10,11,19 The utilization of prognostic indicators such as serum albumin in early detection of spinal cord injured with adverse outcome may reduce the incidence of complications.…”

Albuminemia e terapia medicamentosa no prognóstico de idosos hospitalizados

“…A pesquisa demonstrou que a maioria dos idosos investigados quanto aos níveis de albumina sérica apresentaram hipoalbuminemia, porcentual que pode estar subestimado já que para parte da população investigada não foi solicitado os níveis séricos desta proteína, apesar de estudos evidenciarem o nível sérico de albumina como preditor de risco de morte 15,16 .…”

“…Estudos relatam proporção inversa entre os níveis de albumina com o tempo de internação hospitalar, morbidade e mortalidade, evidenciando o nível sérico de albumina como preditor de risco de morte 15,16 . A associação da morbi-mortalidade decorrente de complicações advindas da hipoalbuminemia pode incluir as alterações farmacocinéticas associadas ao uso de medicamento com afinidade por esta proteína.…”

Impact of combination medical therapy on mortality in vascular surgery patients

“…We also controlled for the use of clonidine and serum albumin, both strong predictors of death after noncardiac surgery. 22,39 Second, we utilized administrative ICD-9 code data for abstraction, and utilized only documented and coded comorbidities in the VA database. Unmeasured confounders may exist.…”