Association Between Postoperative Decrease of Albumin and Outcomes in Patients Undergoing Craniotomy for Brain Tumors

Abstract

Serum albumin reflects nutritional status and is associated with postoperative complications and mortality. Delta albumin (ΔAlb), defined as the difference between preoperative and lowest postoperative levels, could predict complications and mortality, even with postoperative levels above 30g/L prompting albumin infusions. This study aimed to assess how ΔAlb relates to outcomes in craniotomy patients with brain tumors. This retrospective study screened patients diagnosed with a brain tumor who underwent cerebral surgery from a single Chinese hospital between December 2010 and April 2021. Patients were divided into 4 groups based on their ΔAlb levels: <5g/L (normal), 5-9.9g/L (mild ΔAlb), 10-14.9g/L (moderate ΔAlb), and ≥15g/L (severe ΔAlb). The primary outcome was postoperative 30-day mortality. Among the 9660 patients undergoing craniotomy for brain tumors, the median ΔAlb level after craniotomy was 7.3g/L. ΔAlb was associated with increased postoperative 30-day mortality; odds ratios for mild, moderate, and severe ΔAlb were 1.93 (95% confidence interval [CI], 1.17-3.18, P= 0.01), 2.21 (95% CI, 1.28-3.79, P= 0.004), and 7.26 (95% CI, 4.19-12.58, P<0.01), respectively. Significantly, ΔAlb >5g/L was found to have a strong association with a higher risk of mortality, even when the nadir Alb remained greater than 30g/L (odds ratio, 1.84; 95% CI, 1.13-3.00, P= 0.014). Among patients undergoing craniotomy for brain tumor resection, a mild degree of ΔAlb was associated with increased 30-day mortality, even if the nadir Alb remained greater than 30g/L. Moreover, ΔAlb was associated with postoperative complications and longer lengths of stay.