Preoperative hypoalbuminaemia in liver surgery: an observational study at a university medical centre

• Published in: BMJ open Vol. 13; no. 5; p. e068405
• Main Authors: Kuhlmann, Anna Dorothea, Spies, Claudia, Schulte, Erika, Jara, Maximilian, von Haefen, Clarissa, Mertens, Mandy, Süß, Laura Anouk, Winkler, Nathalie, Lachmann, Gunnar, Lachmann, Cornelia
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 18.05.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Academic Medical Centers; Adult intensive & critical care; Alcohol use; Anaesthesia; Anaesthesia in oncology; Ascites; Clinical Trial; Delirium; Hepatectomy; Hepatobiliary disease; Hepatobiliary surgery; Humans; Hypoalbuminemia - epidemiology; Laboratories; Liver; Liver cancer; Liver cirrhosis; Metastasis; Mortality; NUTRITION & DIETETICS; Observational studies; Patients; Postoperative Complications - epidemiology; Postoperative period; Risk Factors; Serum Albumin; Surgery; NUTRITION & DIETETICS; Clinical Trial; Hepatobiliary disease; Anaesthesia in oncology; Hepatobiliary surgery; Adult intensive & critical care
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-068405

ObjectivesPreoperative hypoalbuminaemia is associated with adverse outcome, including increased postoperative mortality in cardiovascular surgery, neurosurgery, trauma and orthopaedic surgery. However, much less is known about the association between preoperative serum albumin and clinical outcomes after liver surgery. In this study, we sought to determine whether hypoalbuminaemia before partial hepatectomy is associated with a worse postoperative outcome.DesignObservational study.SettingUniversity Medical Centre in Germany.ParticipantsWe analysed 154 patients enrolled in the perioperative PHYsostigmine prophylaxis for liver resection patients at risk for DELIrium and postOperative cognitive dysfunction (PHYDELIO) trial with a preoperative serum albumin assessment. Hypoalbuminaemia was defined as serum albumin <35 g/L. Subgroups classified as hypoalbuminaemia and non-hypoalbuminaemia consisted of 32 (20.8%) and 122 (79.2%) patients, respectively.Outcome measuresThe outcome parameters of interest were postoperative complications according to Clavien (moderate: I, II; major: ≥III), length of intensive care unit (ICU) stay, length of hospital stay and survival rates 1 year after surgery.ResultsPreoperative hypoalbuminaemia was associated with the occurrence of major postoperative complications (OR 3.051 (95% CI 1.197 to 7.775); p=0.019) after adjusting for age, sex, randomisation, American Society of Anesthesiologists physical status, preoperative diagnosis and Child-Pugh class. Both ICU and hospital lengths of stay were significantly prolonged in patients with preoperative hypoalbuminaemia (OR 2.573 (95% CI 1.015 to 6.524); p=0.047 and OR 1.296 (95% CI 0.254 to 3.009); p=0.012, respectively). One-year survival was comparable between patients with and without hypoalbuminaemia.ConclusionsWe found that low serum albumin before surgery was associated with a worse short-term outcome after partial hepatectomy, which strengthens the prognostic value of serum albumin in the setting of liver surgery.Trial registration numbersISRCTN18978802 and EudraCT 2008-007237-47.