Effects of Serum Albumin Level in Section Lower vs Upper Extremity Surgery: A Hospital-based Retrospective Study

Abstract

Introduction: Trauma and major surgery often lead to low serum albumin level in patients. Several studies have been reported showing depressed serum albumin level in upper, lower extremity and other major surgery. Metabolic stress response from major surgical interventions and prolonged immobility are primarily responsible for low serum albumin level in these patients. Aim: To investigate the preoperative and postoperative serum albumin levels in patients who underwent extremity surgery and compare the changes in albumin levels between those who underwent upper extremities surgery versus lower extremities surgery. Materials and Methods: This was a hospital-based retrospective study, including 120 patients, who presented to the Emergency Department of Surgery and Orthopaedics, in Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India, due to trauma included in the present study (on and from November 30 2018 to November 30 2021). All the patients underwent either lower or upper extremity surgery (Group 1 and Group 2, respectively) by orthopaedic surgeons and were consecutively selected regardless of their ages. The serum albumin levels at the time of admission and on the third day after surgery were obtained from the hospital patient records. Continuous variables were expressed as mean±standard deviation. The normality test of the numerical variables using Kolmogorov-Smirnov test. Results: Mean age of population in the upper extremities surgery group was 38.8 years vs 30.5 years in the lower extremities. A statistically significant difference in the preoperative and postoperative serum albumin levels was found in both groups (p<0.05). Moreover, the mean difference between preoperative and postoperative serum albumin levels was found to be significantly higher in the lower extremity group (1.52±0.32 gm/dL) than in the upper extremity group (0.95±0.39 g/dL) (p<0.05) and the coefficient of correlation between these two groups r> 0.7 indicating significant difference between albumin levels in two groups. Conclusion: This study revealed that both upper and lower extremity surgeries caused hypoalbuminemia. The study was novel in finding that lower extremity surgery caused more severe hypoalbuminemia in the patients compared with the patients of upper extremity surgery. A correlation study done between two groups and was found to be significant with p-value <0.05 and r value> 0.7. The reason for this significant difference was the longer duration of lower extremity surgery requiring more fluid support during the surgery and resultant increased metabolic stress.