The role of pre-operative serum albumin level in predicting the severe post-operative complications of major gastrointestinal surgery: A Prospective observational study

Abstract

Introduction The prevalence of malnutrition is 30-50% in the hospital inpatients. Serum albumin level is an easily available indicator of preoperative nutritional status. The pre-operative hypoalbuminemia predisposes to post-operative morbidity and mortality. The post-operative complication grading system following major gastrointestinal surgery by Clavien- Dindo enables objective assessment of the severity. Aim To study the role of preoperative serum albumin as a predictor of severe post-operative complications after major gastrointestinal surgery. Materials & methods It is a prospective observational study conducted from October 2016 to April 2018 in a tertiary care center of northern India. All patients undergoing the major gastrointestinal surgery after exclusion of those with a predefined criteria constitute the study population. The pre –operative serum albumin level was determined. Patients were categorized according to the serum albumin level after calculating the cutoff from the data collected. The outcome variables like severity of post-operative complications, duration of ICU, length of hospitalization and mortality were analyzed. Results We have studied 100 patients of which 65 (65%) were males and 35 (35%) were females. Twenty two (22%) patients developed severe (Clavien-Dindo Grade ≥ 3) post-operative complications. The preoperative albumin level, intraoperative blood loss and the need for the blood transfusion was found to be the significant predictor of sever post-operative complications. The cut off value of pre-operative albumin level for the prediction of severe post operative complications was calculated to be 3.1 gm/dL (95% CI 0.64- 0.87; p value less than 0.001). The correlation between pre-operative albumin level and post-operative complication severity on simple linear regression analysis was found to be statistically significant with R2=0.133 and  co-efficient of -0.689 (p<0.001). Statististically significant correlation between preoperative serum albumin and duration of ICU, length of hospitalisation was identified. The cut off serum albumin level for postoperative mortality was 3.5gm/dl (AUC= 0.7) which was statistically insignificant (p=0.104). Conclusion Pre-operative hypoalbuminemia with the level less than 3.1gm/dL can predict higher grades of complications, increased length of hospitalization and ICU stay after major gastrointestinal surgeries.