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

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Journal of Gastrointestinal Surgery Aims and scope

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.

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Authors and Affiliations

  1. University Department of Clinical Surgery, Trinity Center for Health Sciences, St. James’s Hospital, Dublin, Ireland

    Aoife M. Ryan, Ruth S. Prichard, Aileen Cunningham, Suzanne P. Rowley & John V. Reynolds

  2. Department of Clinical Medicine, Trinity Center for Health Sciences, St. James’s Hospital, Dublin, Ireland

    Aine Hearty

Authors
  1. Aoife M. Ryan
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  2. Aine Hearty
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  3. Ruth S. Prichard
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  4. Aileen Cunningham
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  5. Suzanne P. Rowley
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  6. John V. Reynolds
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Correspondence to John V. Reynolds.

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Ryan, A.M., Hearty, A., Prichard, R.S. et al. Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy. J Gastrointest Surg 11, 1355–1360 (2007). https://doi.org/10.1007/s11605-007-0223-y

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  • DOI: https://doi.org/10.1007/s11605-007-0223-y

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