Research Article| Volume 220, ISSUE 2, P432-437, August 2020

Predicting morbidity and mortality in laparoscopic cholecystectomy: Preoperative serum albumin still matters

Published:December 05, 2019DOI:


      • 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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