Advertisement

Journal of Gastrointestinal Surgery

, Volume 11, Issue 10, pp 1355–1360 | Cite as

Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy

  • Aoife M. Ryan
  • Aine Hearty
  • Ruth S. Prichard
  • Aileen Cunningham
  • Suzanne P. Rowley
  • John V. Reynolds
Article

Abstract

Objective

Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute albumin level on the first postoperative day was of value in predicting in-hospital complications.

Methods

A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and 2005 was performed. Patients who had pre and postoperative (days 1, 3, and 7) serum albumin levels measured were included in the study. Patients were subdivided into three postoperative albumin categories <20 g/l, 20–25 g/l, >25 g/l. Logistic regression analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level.

Results

Patients with an albumin of less than 20 g/l on the first postoperative day were twice as likely to develop postoperative complications than those with an albumin of greater than 20 g/l (54 vs 28% respectively, p < 0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome (22 vs 5%, p < 0.001), respiratory failure (27 vs 8%, p < 0.01) and in-hospital mortality (27 vs 6% (p < 0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications (odds ratios, 0.89: 95%; confidence intervals, 0.83–0.96; p < 0.005). In addition, albumin <20 g/l on the first postoperative day was associated with the need for further surgery and a return to ICU.

Conclusion

Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes.

Keywords

Albumin Esophagectomy Morbidity Mortality Complications 

References

  1. 1.
    Bailey SH, Bull DA, Harpole DH, Rentz JJ, Neumayer LA, Pappas TN, Daley J, Henderson WG, Krasnicka B, Khuri SF. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg 2003;75(1):217–22 (Jan).PubMedCrossRefGoogle Scholar
  2. 2.
    Bartels H, Stein HJ, Siewert JR. Pre operative risk analysis and post operative mortality of esophagectomy for resectable oesophageal cancer. Br J Surg 1998;85:840–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Ferguson MK, Martin TR, Reeder LB, Olak J. Mortality after esophagectomy: risk factor analysis. World J Surg 1997;21:599–604.PubMedCrossRefGoogle Scholar
  4. 4.
    Lund O, Kimose HH, Aagaard MT et al. Risk stratification and long-term results after surgical treatment of carcinomas of the thoracic esophagus and cardia. A 25-year retrospective study. J Thorac Cardiovasc Surg 1990;99:200–9.PubMedGoogle Scholar
  5. 5.
    Sweeney KJ, Kell MR, Ravi N, Reynolds JV. Major upper gastrointestinal surgery is associated with an antigen-dependent proinflammatory T cell response. Br J Surgery 2005;92(8):989–95 (Aug).CrossRefGoogle Scholar
  6. 6.
    Desborough JP. The stress response to trauma and surgery. Br J Anaesthesia 2000;85(1):109–17.CrossRefGoogle Scholar
  7. 7.
    Karaylannakis AJ, Makri GG, Mantzioka A, Karousos D. Systemic stress response after laparoscopic or open cholecyctectomy: a randomized trial. Br J Surg 1997;84:467–71.CrossRefGoogle Scholar
  8. 8.
    Fogler C, Lindsey RW. C-Reactive Protein in orthopaedics. Orthopaedics 1998;21:687–91.Google Scholar
  9. 9.
    Pepys MB, Hirschfield GM. C-Reactive Protein: a critical update. J Clin Investigation 2003;111(12):1805–12.CrossRefGoogle Scholar
  10. 10.
    Bone RC, Sibbald WJ, Spring CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992;101:1481–3.PubMedGoogle Scholar
  11. 11.
    Jamieson GG, Mathew G. Surgical management of oesophageal cancer: the western experience. In: Daly JM, Hennessy TPJ, Reynolds JV eds. Management of Upper Gastrointestinal Cancer. London: WB Sanders, 1999, pp 183–99.Google Scholar
  12. 12.
    Hulscher JB, Tijssen JG, Obertop H et al. Transthoracic versus transhiatal resection for carcinoma of the oesophagus: a meta-analysis. Ann Thorac Surg 2001;72:306–13.PubMedCrossRefGoogle Scholar
  13. 13.
    Doty JR, Salazar JD, Forastiere AA et al. Post-esophagectomy morbidity, mortality and length of hospital stay after preoperative chemoradiation therapy. Ann Thorac Surg 2002;74:227–31.PubMedCrossRefGoogle Scholar
  14. 14.
    Eguchi R, Ide H, Nakamura T et al. Analysis of postoperative complications after esophagectomy for esophageal cancer in patients receiving neoadjuvant therapy. Jpn J Thorac Cardiovasc Surg 1999;47:552–8.PubMedGoogle Scholar
  15. 15.
    Urschel JD. Esophagogastrostomy anastomotic leak rates complicating esophagectomy: A review. Am J Surg 1995;169:634–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Gandhi SK, Naunheim KS. Complications of transhiatal esophagectomy. Chest Surg Clin N Am 1997;7:601–10.PubMedGoogle Scholar
  17. 17.
    Daly JM, Fry WA, Little AG et al. Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study. J Am Coll Surg 2000;190:562–72.PubMedCrossRefGoogle Scholar
  18. 18.
    Gibbs J, Cull W, Henderson W et al. Preoperative serum albumin level as a predictor of operative mortality and morbidity. Arch Surg 1999;134:36–42.PubMedCrossRefGoogle Scholar
  19. 19.
    Schwartz SR, Yueh B, Maynard C et al. Predictors of wound complications after laryngectomy: A study of over 2000 patients. Otolaryngol Head Neck Surg 2004;131(1):61–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Dewar L, Gelfand G, Finley RJ, Evans K, Inculet R, Nelems B. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg 1992;163(5):484–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Rey-Ferro M, Castano R, Orozco O, Serna A, Moreno A. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition 1997;13(10):878–81 (Oct).PubMedCrossRefGoogle Scholar
  22. 22.
    Mullen JL, Gertner MH, Buzby GP. Implications of malnutrition in the surgical patient. Arch Surg 1979;114:121–5.PubMedGoogle Scholar
  23. 23.
    Buzby GP, Mullen JL, Matthews DC. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980;139:160–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Detsky AS, Baker JP, O’Rourke K. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. J Parenter Enter Nutr 1987;11:440–6.Google Scholar
  25. 25.
    Kudsk KA, Tolley EA, DeWitt C et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. J Parenter Enter Nutr 2003;27:1–9.CrossRefGoogle Scholar
  26. 26.
    Soeters PB, Von Meyenfeldt MF, Meijerink WJHJ et al. Serum albumin and mortality (Letter). Lancet 1990;335:348.CrossRefGoogle Scholar
  27. 27.
    Spanga G, Siegel JH, Brown G et al. Reprioritization of hepatic plasma protein release in trauma and sepsis. Arch Surg 1985;120:187–98.Google Scholar
  28. 28.
    Dowd PS, Heatly RV. The influence of undernutrition on immunity. Clin Sci 1984;66:241–8.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Aoife M. Ryan
    • 1
  • Aine Hearty
    • 2
  • Ruth S. Prichard
    • 1
  • Aileen Cunningham
    • 1
  • Suzanne P. Rowley
    • 1
  • John V. Reynolds
    • 1
  1. 1.University Department of Clinical Surgery, Trinity Center for Health SciencesSt. James’s HospitalDublinIreland
  2. 2.Department of Clinical Medicine, Trinity Center for Health SciencesSt. James’s HospitalDublinIreland

Personalised recommendations