Pre-operative Hypoalbuminemia in Colorectal Cancer Patients Undergoing Elective Surgery - A Major Risk Factor for Postoperative Outcome
D. Ionescu, C. Tibrea, C. PuiaOriginal article, no. 6, 2013
Background: The incidence of hypoalbuminemia in surgicalpatients varies in different studies with age, tumor stage, timeinterval to the first referral to a doctor, symptoms of disease andnutritional habits of the population. The main objective of thisstudy was to evaluate the incidence of hypoalbuminemia in colorectal cancer patients undergoing scheduled surgery in anacademic hospital in Romania and the impact of hypoalbuminemiaon perioperative outcome. The secondaryobjective was to identify other possible risk factors for the postoperativeoutcome.Material and Methods: 252 patients undergoing scheduledcolorectal surgery with anastomosis have been enrolled in thestudy. Incidence of hypoalbuminemia (serum albumin 3.5 g dL), fistulas and other postoperative complications (e.g.infections) has been evaluated. LOS and 30-days mortality havealso been evaluated comparatively in patients with normal andlow serum albumin.Results: 28.9% of our patients were hypoalbuminemic. Theincidence of fistulas was 5.5 % in the study group and 2.3% and13.3% in patients with normal serum albumin and hypoalbuminemicpatients, respectively (p=0.001). Multivariateanalysis showed that the OR was 6.65 [95% CI:2.01-21.96] inpatients with moderate hypoalbuminemia and 24.75 [95% CI:6.75-90.67] in patients with severe hypoalbuminemia.Association between alcohol consumption and smokingincreased risk ratio to 1.96 [95% CI: 0.51-7.46].Conclusion: The high incidence of hypoalbuminemia in ourpatients justifies preoperative nutritional interventions andspecific surgical protocols in emergency cases. Further studiesare needed to exactly quantify the impact of smoking andalcohol consumption on postoperative outcome.
