Preoperative serum albumin level as independent predictor of surgical outcome in acute abdomen

Authors

  • Kanakeswar Bhuyan Department of Surgery, Gauhati Medical College & Hospital, Guwahati, Assam, India
  • Smita Das Department of Clinical Haematology, Gauhati Medical College & Hospital, Guwahati, Assam, India

DOI:

https://doi.org/10.18203/2349-2902.isj20160242

Keywords:

Serum albumin, Surgery, Morbidity, Mortality

Abstract

Background: The prognostic implications and significance of hypoalbuminemia after surgical intervention is significant. In this study, we assess the predictive value of preoperative serum albumin level on postoperative morbidity and mortality following surgical intervention in acute abdomen.

Methods: In this retrospective study, Medical records of 110 patients with estimated preoperative serum albumin level undergoing exploratory laparotomy with acute abdominal conditions in a tertiary health care centre were reviewed. Patients with record of preoperative serum albumin level were reviewed. Albumin less than 3.2 g/dL was recognized as hypoalbuminemia. Types of surgery, postoperative complications, and mortality rates were collected. The association between preoperative serum albumin level and postoperative morbidity and mortality was assessed.

Results: Preoperative serum albumin level of 3.2g/dl was found in 33 (30%) cases and 77 (70%) patients had same or less than 3.2g/dl albumin. Patients with preoperative serum albumin less than 3.2 g/dL had complications in 50 (45.5%) cases than that of normal preoperative albumin levels (07: 5.5%; p=<0.0001, 95% CI=0.119-0.528). There was total mortality of 15 (14%). High Mortality of 14 (18%) patients was found in patients with low albumin group. There was 3% mortality with normal serum albumin level (P=<0.362; 95% CI=0.029-1.34). Skin and soft tissue infections were found in 5 (15%) cases with albumin >3.2g/dl and 28 cases with less than 3.2g/dl (p=<0.397; 95%CI= 0.17-0.98). Chest infections were found in 2 cases (6%) with >3.2g/dl serum albumin against 20 cases (25%) with less than 3.2g/dl. (p=0.0187; 95% CI=0.066-0.997).

Conclusions: Preoperative hypoalbuminemia is an independent risk factor for postoperative complications after emergency laparotomy.    

References

Boyd O, Jackson N. Clinical review: How is risk defined in high-risk surgical patient management? Critical Care. 2005;9:390-6.

Mella J, Biffin A, Radcliffe AG, Stamatakis JD, Steele RJ. Population-based audit of colorectal cancer management in two UK health regions.

Colorectal Cancer Working Group, Royal College of Surgeons of England Clinical Epidemiology and Audit Unit. Br J Surg. 1997,84:1731-6.

Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee T-S. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1988,94:1176-86.

Boyd O, Grounds RM, Bennett ED. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA. 1993;270:2699-707.

Gibbs J, Cull W, Henderson W. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134:36-42.

Peralta R. Hypoalbuminemia. Medscape Updated Clinical Reference. 2010. http://emedicine.medscape.com/article/166724. Accessed online from August 18, 2011.

Jhabta RS, Attri AK, Kaushik R. Spectrum of perforation peritonitis in India- Review of 504 consecutive cases. W J S. 2006;1:26.

Hennessey, Derek BMB, BAO, BCh, BMedSci, MRCSI. 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;252(2):325-9.

Koertzen M, Punjabi P, Lockwood G. Pre-operative serum albumin concentration as a predictor of mortality and morbidity following cardiac surgery: Perfusion. 2013;28(5):390-4.

Møller MH, Adamsen S, Thomsen RW, Møller AM. Preoperative prognostic factors for mortality in peptic ulcer perforation: a systematic review. 2010. doi: 10.3109/00365521003783320.

Herrmann FR, MPH, Charles Safran. Serum Albumin Level on Admission as a Predictor of Death, Length of Stay, and Readmission ;Arch Intern Med. 1992;152(1):125-30.

Aahlin EK, Tranø G, Johns N. Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study. BMC Surg. 2015;15:83.

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Published

2016-12-13

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Original Research Articles