The Association between Serum Albumin and Post-Operative Outcomes among Patients Undergoing Common Surgical Procedures: An Analysis of a Multi-Specialty Surgical Cohort from the National Surgical Quality Improvement Program (NSQIP)

Cole A. Nipper, Kelvin Lim, Carlos Riveros, Enshuo Hsu, Sanjana Ranganathan, Jiaqiong Xu, Michael Brooks, Nestor Esnaola, Zachary Klaassen, Angela Jerath, Amanda Arrington, Christopher J.D. Wallis, Raj Satkunasivam

Research output: Contribution to journalArticlepeer-review

Abstract

While studies have demonstrated an association between preoperative hypoalbuminemia and adverse clinical outcomes, the optimal serum albumin threshold for risk-stratification in the broader surgical population remains poorly defined. We sought define the optimal threshold of preoperative serum albumin concentration for risk-stratification of adverse post-operative outcomes. Using the American College of Surgeons National Surgical Quality Improvement Program Database, we identified 842,672 patients that had undergone a common surgical procedure in one of eight surgical specialties. An optimal serum albumin concentration threshold for risk-stratification was determined using receiver-operating characteristic analysis. Multivariable logistic regression analysis was used to evaluate the odds of adverse surgical events; a priori defined subgroup analyses were performed. A serum albumin threshold of 3.4 g/dL optimally predicted adverse surgical outcomes in the broader cohort. After multivariable analysis, patients with hypoalbuminemia had increased odds of death within 30 days of surgery (odds ratio [OR] 2.01, 95% confidence interval [CI] 1.94–2.08). Hypoalbuminemia was associated with greater odds of primary adverse events among patients with disseminated cancer (OR 2.03, 95% CI 1.88–2.20) compared to patients without disseminated cancer (OR 1.47, 95% CI 1.44–1.51). The standard clinical threshold for hypoalbuminemia is the optimal threshold for preoperative risk assessment.

Original languageEnglish (US)
Article number6543
JournalJournal of Clinical Medicine
Volume11
Issue number21
DOIs
StatePublished - Nov 2022
Externally publishedYes

Keywords

  • albumin
  • NSQIP
  • preoperative risk stratification
  • serum albumin
  • surgical outcomes

ASJC Scopus subject areas

  • Medicine(all)

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