Preoperative Hypoalbuminemia and Development of Surgical Site Infection and Anastomotic Leakage in Emergency Colorectal Surgery

Abstract

Background: Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoperative optimization and intervention in emergency colorectal surgeries. Objectives: Therefore, this study aimed to assess the relationship between preoperative serum albumin levels and the development of SSI and AL in emergency colorectal surgery patients. Methods: In this cohort study, patients who underwent emergency colorectal surgery during 17 months, were assessed. Albumin level was measured before surgery, and patients were followed for 1 month after surgery to identify the development of SSI and AL. Results: In total, 173 patients were enrolled in the study, but data analysis was performed on 170 patients. They were divided into hypoalbuminemia group (n=98, 57.6%) and non-hypoalbuminemia group (n=72, 42.4%). The mean ages of patients in each group were 57.17±16.19 and 51.61±16.14 years old, respectively (P=0.028). The AL was observed in 4 (2.4 %) patients; 3 patients in the hypoalbuminemia group and one patient in the non-hypoalbuminemia group (P=0.205, relative risk=2.33, 95% CI: 0.42-12.82). The SSI was observed in 13 patients (7.6%) during the 1-month follow-up; 8 patients (5.1%) had superficial SSI and 5 (3.2%) had deep ones. Albumin level was significantly lower in patients with AL (2.9±0.48), compared to those without AL (3.6±0.7 g/dL). Moreover, albumin level was higher in patients with SSI (3.11±0.62), compared to patients without SSI (3.6±0.7 g/dL). The incidence of complications, either AL or SSI, was significantly higher in hypoalbuminemia patients, compared to non-hypoalbuminemia patients (P=0.017, Odds Ratio=4.24, 95% CI: 1.29-13.9). Adjusted OR for age was 3.82 (95% CI: 1.15-12.75, P=0.029); therefore, a 13.5% reduction in OR indicated that age is a confounding factor. Conclusion: Preoperative hypoalbuminemia was significantly associated with post-development of complications in emergency colorectal surgery and older age and lower preoperative albumin levels may serve as valuable indicators for the identification of patients at higher risk of complications.