Serum Albumin is a Predictor for Postoperative Morbidity and Mortality in Gastrointestinal Surgeries

Abstract

Introduction: The purpose of nutritional support in the surgical patient is to prevent or reverse the catabolic effects of disease or injury. Protein depletion results in delayed wound healing and many other complications. Serum albumin levels at the time of admission were found to be a very useful predictor of such complications. The ultimate validation for nutritional support in surgical patients should be improvement in clinical outcome and restoration of function. Aim: To find the relationship between serum albumin level <3 g/dL and the development of complications and mortality rate among patients following laparotomy for Gastrointestinal (GI) diseases. Materials and Methods: Ninety nine patients, more than 18 years of age with serum albumin level <3 g/dL, posted for emergency and elective laparotomy for GI diseases were included in the study. The following assessments were done: pre-operative evaluation of serum albumin, nutritional assessment (Mid Upper Arm Circumference, Skin Fold Thickness) along with Body Mass Index (BMI) and post-operative evaluation of serum albumin after 48 hours and 7 days. Early and late (30 day) post-operative complications were studied. Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Multiple Regression Analysis. Results: Maximum numbers of patients were in the age group 40-59 years and 59 patients (59.60%) developed post-operative complications. Surgical Site Infection (SSI) was seen in majority (32.32%) of the patients as early post-operative complication and wound dehiscence was the most common late complication (9.09%). Most of the early post-operative complications were present in patients with serum albumin level 2.1-2.7 gm/dL (43.43%). The relation between pre-operative serum albumin and early and late post-operative complications was found to be statistically significant. There was a significant co-relation between age, BMI and complications. There were four deaths in the study. Conclusion: Pre-operative Hypoalbuminemia <3.0 gm/dL is a strong and independent risk factor for post-operative morbidity and mortality in GI surgeries and BMI is a strong indicator for post-operative complications.

Keywords

• body mass index
• hypoalbuminemia
• risk factor
• surgical site infection