O. Trofymenko1, E. Telemi1, R. Venkat1, V. Nfonsam1 1University Of Arizona,Surgery,Tucson, AZ, USA
Introduction: Colorectal cancer is second most common cause of cancer related deaths in the United States. Many patients with benign neoplasms in colon and rectum undergo colectomy to prevent the development of malignancy. Preoperative serum albumin has been used to predict postoperative complication rates in colectomies.
Methods: NSQIP cross-institutional database was used for this study. The database contains records of more than 139 variables from multiple surgery types around United States from 2005 until 2012. 2068 patient records (n = 2,068) with a primary diagnosis of benign colorectal neoplasm who had elective colectomy performed were identified and used in the study. 75.48% underwent laparoscopic (n = 1,561) and 24.52% open (n = 507) colectomies. Preoperative serum albumin is a previously described and validated metric to describe the risk of surgery. Outcome measures included serious morbidity, overall morbidity, Clavien IV (requiring ICU), and Clavien V (mortality) complications.
Results: Median age was 65 years, and BMI was 28.0Kg/m2. 49.4% of patients were males. 45.9% of patients were assigned ASA Class 3 or higher. The median albumin was 4.1 (1.9 – 7.3). As preoperative serum albumin changed from less than 3.5 to 3.5 and above, overall morbidity decreased from 34.1% to 12.6% and serious morbidity decreased from 15.9% to 4.8%, respectively. The Clavien IV complications rate decreased from 9.4% to 2.5%. Mortality rate has decreased from 4.4% to 0.6%. All results were statistically significant at p<0.01. On a multivariate analysis preoperative serum albumin was independent predictor of serious morbidity (Adjusted Odd Ratio (AOR): 0.47, p<0.05), overall morbidity (AOR: 0.48, p<0.01), Clavien IV complication rates (AOR: 0.35, p<0.05) and mortality (AOR: 0.08, p<0.01), independent of age, sex, BMI, ASA class, modified frailty, type of colectomy (laparoscopic or open), and wound class.
Conclusion: As future patients undergo elective colectomies in treatment of benign neoplasm, low preoperative serum albumin should be used as a proxy for postoperative complications helping patients and physicians make a better informed decision with regards to the surgery.