Preoperative hypoalbuminemia is associated with an increased risk for intra-abdominal septic complications after primary anastomosis for Crohn’s disease

Abstract

ObjectiveThe aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intra-abdominal septic complications (IASCs) after primary anastomosis for patients with Crohn’s disease (CD).MethodsAll CD patients undergoing bowel resection with a primary anastomosis during the study period from 2007 to 2015 were enrolled. The association of preoperative hypoalbuminemia (<30 g/L) with the risk for IASCs were assessed using both univariate and multivariate analyses.ResultsA total of 124 eligible patients were included, 117 (94.4%) of whom had available preoperative albumin level. Preoperative hypoalbuminemia occurred in 13 (11.7%) patients. The duration from diagnosis to surgery was longer for patients with preoperative hypoalbuminemia than those without (p = 0.012). Patients with preoperative hypoalbuminemia were more likely to have a history of preoperative use of 5-aminosalicylic acid (p = 0.013) and have an intraoperative finding of small bowel obstruction (p = 0.015). Of all patients, 24 (19.4%) developed postoperative IASCs. Univariate analysis showed that patients with preoperative hypoalbuminemia had an increased risk for IASCs (p = 0.012). Multivariate analysis confirmed the association between preoperative hypoalbuminemia and IASCs (odds ratio 4.67, 95% confidence interval: 1.28–17.04, p = 0.02). Similar findings were also obtained when preoperative albumin level was analysed as a continuous variable (p = 0.019).ConclusionsPreoperative hypoalbuminemia is a significant predictor for the development of postoperative IASCs in CD patients after bowel resection with a primary anastomosis. Favorable preoperative nutrition status might lessen the risk for IASCs.

Hypoalbuminemia as Surrogate and Culprit of Infections

“…In inflammatory bowel disease with chronic inflammation, surgical stress increases the risk of postoperative sepsis if preoperative serum albumin levels are low [ 128 , 129 ]. Similarly, in hemodialysis, hypoalbuminemia affects the risk of sepsis in catheter-related bloodstream infection [ 130 ].…”

Impact of albumin levels on clinical outcomes in children underwent abdominal surgery

“…6 Many studies found that albumin levels less than 3 g/dL were associated with post-operative complications. 7,8 Albumin level less than 3.5 g/dL was associated with respiratory complications (pneumonia in 30 days post-operative, delayed ventilator weaning, and reintubation), surgical site infection, dehiscence, longer hospitalization period, and increasing one-year mortality risk. [9][10][11] Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications and higher risk of mortality.…”

“…[9][10][11] Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications and higher risk of mortality. [8][9][10][11] However, the prognostic role of albumin level in children with abdominal surgery remains unclear. Therefore, we aim to investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery.…”

Should we change reference range for serum albumin in major gastrointestinal surgery? Preoperative serum albumin as an important prognostic factor

“…The incidence of preoperative hypoalbuminemia varies between studies. In surgical patients with Crohn's disease, it was shown in 11.7% of patients (Liu et al 2017). In colon cancer patients, it has been shown that 14.5% of patients had preoperative hypoalbuminemia (Haskins et al 2017).…”

“…In surgical patients with Crohn's disease, preoperative hypoalbuminemia (i.e. <3.5gdL À1 ) significantly increased the risk of intra-abdominal septic complications (OR 4.67, 95% CI 1.28-17.04, p ¼ 0.02) (Liu et al 2017). In surgical patients with inflammatory bowel disease, modest and severe hypoalbuminemia in the preoperative period was associated with increased mortality, whereas severe preoperative hypoalbuminemia was associated with septic complications (Nguyen et al 2019).…”