- •Serum albumin predicts outcomes in less invasive laparoscopic cholecystectomy.
- •There is an exponential relationship of preoperative serum albumin with mortality.
- •Hypoalbuminemia is independently associated with postoperative septic shock.
- •Our findings may preoperatively risk stratify laparoscopic cholecystectomy patients.
This study examined the association of preoperative serum albumin with outcomes for laparoscopic cholecystectomy.
The American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed from 2005 to 2016 for adult patients undergoing laparoscopic cholecystectomy. Patients were stratified into four groups: <3.0 g/dL (Severe Malnutrition), 3.0-<3.5 (Moderate Malnutrition), 3.5-<4.0 (Mild Malnutrition), and ≥4.0 g/dL (Normal Nutrition). The primary outcome of 30-day mortality was evaluated with multivariable regression.
Of 131,855 patients, 14.0% had Severe, 22.8% Moderate, and 29.7% Mild Malnutrition, with 33.5% classified as Normal Nutrition. Adjusted multivariable regressions demonstrated that relative to Normal Nutrition, mortality risk was increased for Severe (OR = 3.09 [95% Confidence Interval: 2.09–4.56]) and Moderate (OR = 1.83 [1.24–2.72]) Malnutrition. Severe (OR = 2.45 [1.67–3.61]) and Moderate (OR = 1.52 [1.04–2.24]) Malnutrition were also associated with increased risk of postoperative septic shock.
Even in less invasive laparoscopic cholecystectomy, reduced preoperative serum albumin is strongly associated with increased morbidity and mortality.
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- Hospital outcomes in inpatient laparoscopic cholecystectomy in medicare patients.Ann Surg. 2017; 265: 178-184https://doi.org/10.1097/SLA.0000000000001653
- Ninety-day readmissions after inpatient cholecystectomy: a 5-year analysis.World J Gastroenterol. 2017; 23: 2972https://doi.org/10.3748/wjg.v23.i16.2972
- Laparoscopic subtotal cholecystectomy compared to total cholecystectomy: a matched national analysis.J Surg Res. 2017; 218: 316-321https://doi.org/10.1016/j.jss.2017.06.047
- Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study.Arch Surg Chic Ill. 1960; 134 (1999): 36-42
- The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care.J Am Coll Surg. 1995; 180: 519-531
- Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty.J Arthroplast. 2016; 31: 15-21https://doi.org/10.1016/j.arth.2015.08.028
- Hypoalbuminemia more than morbid obesity is an independent predictor of complications after total hip arthroplasty.J Arthroplast. 2015; 30: 2290-2295https://doi.org/10.1016/j.arth.2015.06.003
- Albumin and surgical site infection risk in orthopaedics: a meta-analysis.BMC Surg. 2017; 17https://doi.org/10.1186/s12893-016-0186-6
- Preoperative hypoalbuminemia is associated with adverse outcomes after ileoanal pouch surgery.Inflamm Bowel Dis. 2012; 18: 1034-1041https://doi.org/10.1002/ibd.21842
- Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery.Ann Surg. 2011; 254: 665https://doi.org/10.1097/SLA.0b013e31823062f3
- User guide for the 2016 ACS NSQIP participant use data file (PUF).(October)
- Sepsis and septic shock: pathogenesis and treatment perspectives.J Crit Care. 2017; 40: 229-242https://doi.org/10.1016/j.jcrc.2017.04.015
- Hypoalbuminemia and clinical outcomes: what is the mechanism behind the relationship?.Am Surg. 2017; 83: 1220-1227
- Early postoperative decrease of serum albumin predicts surgical outcome in patients undergoing colorectal resection.Dis Colon Rectum. 2017; 60: 326-334https://doi.org/10.1097/DCR.0000000000000750
- Preoperative serum albumin level as a predictor of postoperative complication after spine fusion.Spine. 2014; 39: 1513-1519https://doi.org/10.1097/BRS.0000000000000450
- Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies?.Interact Cardiovasc Thorac Surg. 2015; 20: 107-113https://doi.org/10.1093/icvts/ivu324
- Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study.Ann Surg. 2010; 252: 325-329https://doi.org/10.1097/SLA.0b013e3181e9819a
- Postoperative albumin drop is a marker for surgical stress and a predictor for clinical outcome: a pilot study.Gastroenterol Res Pract. 2016; 20168743187https://doi.org/10.1155/2016/8743187
- Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Hepato-Biliary Group.in: Cochrane Database Syst Rev. 2006https://doi.org/10.1002/14651858.CD006231 (October)
- Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study.Crit Care Med. 1994; 22: 613-619https://doi.org/10.1097/00003246-199404000-00017
- Is replacement of albumin in major abdominal surgery useful?.J Clin Anesth. 2011; 23: 42-46https://doi.org/10.1016/j.jclinane.2010.06.007
- Albumin use guidelines and outcome in a surgical intensive care unit.Arch Surg. 2008; 143: 935https://doi.org/10.1001/archsurg.143.10.935
- The effect of malnutrition on patients undergoing elective joint arthroplasty.J Arthroplast. 2013; 28: 21-24https://doi.org/10.1016/j.arth.2013.05.038
- Implications of preoperative hypoalbuminemia in colorectal surgery.World J Gastrointest Surg. 2016; 8: 353https://doi.org/10.4240/wjgs.v8.i5.353
- Laparoscopic sleeve gastrectomy and nutrient deficiencies: a prospective study.Surg Laparosc Endosc Percutaneous Tech. 2016; 26: 208-211https://doi.org/10.1097/SLE.0000000000000270
- Replacement of albumin after abdominal surgery.Crit Care. 2007; 11: P405https://doi.org/10.1186/cc5565
- Use of albumin: an update.Br J Anaesth. 2010; 104: 276-284https://doi.org/10.1093/bja/aep393
- Albumin administration in the acutely ill: what is new and where next?.Crit Care. 2014; 18: 231https://doi.org/10.1186/cc13991
Published online: December 05, 2019
Accepted: December 3, 2019
Received in revised form: November 25, 2019
Received: March 12, 2019
© 2019 Published by Elsevier Inc.