M. Matecki1, J. Atahar1, J. Zarkower1, M. Seebald1, M. Ng1, S.K. MD1 1George Washington University School Of Medicine And Health Sciences, Surgery, Washington, DC, USA
Introduction:
Cancer patients undergoing colorectal surgeries are at risk of complications. Hypoalbuminemia has been linked with poor outcome in many cancer patients. While it is no longer considered as a marker for nutrition, low albumin level has been linked to inflammatory processes that include weight loss. In this study we attempt to study the relationship between low albumin and the outcome of open colectomy.
Methods:
Adult patients with colon cancer who had open colectomies in ACS NSQIP 2005-2021 were analyzed. Univariable and multivariable logistic regression was used to evaluate the relationship of preoperative serum albumin levels, weight loss, and surgical outcomes. Preoperative serum albumin was made into a dichotomous variable at or above 3.5 mg/dL vs below 3.5 mg/dL. Analyses were adjusted for sex, age, diabetes, weight loss, preoperative WBC, smoking, immunosuppressive therapy, and dialysis. Subjects with missing values, ascites, and emergency colectomies were dropped.
Results:
Among 41,552 patients, 14,154 had a preoperative serum albumin below 3.5 mg/dL. These patients were more likely to be older, female, diabetic, current smoker within one year, greater than 10% weight loss in the past 6 months, increased preoperative WBC, taking a steroid or immunosuppressant, and currently on dialysis upon univariable analysis. After adjustment, the analysis showed increased likelihood of superficial SSI (OR 1.16, 95% CI 1.06-1.27), deep SSI (OR 1.45, 95% CI 1.19-1.78), organ space SSI (OR 1.29, 95% CI 1.16-1.43), pneumonia (OR 1.67, 95% CI 1.49-1.87), unplanned intubation (OR 2.08, 95% CI 1.82-2.38), pulmonary embolism (OR 1.39, 95% CI 1.12-1.73), UTI (OR 1.24, 95% CI 1.10-1.40), cardiac arrest (OR 1.91, 95% CI 1.51-2.43), DVT (OR 1.74, 95% CI 1.48-2.05), sepsis (OR 1.68, 95% CI 1.50-1.87), and unplanned reoperation (OR 1.29, 95% CI 1.17-1.42) for low preoperative albumin compared to at or above 3.5 mg/dL. Patients with preoperative serum albumin below 3.5 mg/dL had a total length of stay approximately 3.78 days longer than the reference group (95% CI 3.62-3.94).
Conclusion:
Our study showed significant associations between hypoalbuminemia with adverse operative outcome such as SSIs, pneumonia, unplanned intubation, pulmonary embolism, UTI, cardiac arrest, DVT, sepsis, unplanned reoperation, and longer hospital length of stay when compared to normal serum albumin levels. Future studies are needed to study whether modification of inflammation or nutritional status correspond to albumin level and operative outcomes.