Preoperative serum albumin is associated with mortality and complications after radical cystectomy

Abstract

Objective To determine the association between preoperative serum albumin and mortality and postoperative complications after radical cystectomy and urinary diversion. Patients and Methods We conducted a retrospective review of 1097 radical cystectomies performed for the treatment of bladder cancer between 1992 and 2005. All data were entered prospectively into a hospital-based complications database. We used multivariable logistic regression to assess the association between preoperative serum albumin and complications and mortality within 90 days of surgery, while controlling for preoperative patient and disease characteristics. Results Low preoperative serum albumin was identified in 14% of the cohort. Preoperative serum albumin was a predictor of postoperative complications (adjusted odds ratio [OR] per unit increase in albumin: 0.61, 95% confidence interval [CI] 0.42–0.90) and 90-day mortality (OR 0.33, 95% CI 0.14–0.75) when controlling for sex, race, age-adjusted Charlson score, body mass index, prior history of abdominal surgery, clinical stage, and neoadjuvant chemotherapy. As serum albumin decreased, the risk of complications and mortality increased. Conclusions In addition to age-adjusted Charlson score, low preoperative serum albumin is a significant predictor of complications and mortality after radical cystectomy. Serum albumin testing can be used to identify individuals at high-risk for morbidity and mortality.

Nutritional predictors of complications following radical cystectomy

“…Garg et al also demonstrated that hypoalbuminemia significantly increased the risk of complications within 90 days of RC. 12 Specifically, neurologic and wound complications occurred more frequently in patients with decreased pre-operative serum albumin, while other major complications, including cardiac, gastrointestinal, genitourinary, infectious, bleeding, pulmonary, and thromboembolic were not significantly associated. Despite a larger cohort (N=1097), this series included only patients from a single tertiary specialty oncology hospital.…”

“…11,12 Lambert et al reported that patients with a serum albumin < 3.5 g/dL had a 22% greater overall complication rate compared to patients with a normal albumin (>3.5 g/dL), even when controlling for multiple covariates. 11 However, their sample size was small (n = 187), and the study was not specifically designed to evaluate complications, which were therefore neither systematically nor prospectively ascertained.…”

“…5–7 However, only a small number of studies examine nutritional predictors of surgical outcomes after urologic procedures. 4,8–12 While nutritional deficiency lacks a universal definition, researchers and clinicians often define malnutrition using a combination of unintentional weight loss, suboptimal body mass index (BMI), and poor appetite/anorexia. 13 Additionally, serum markers such as albumin and prealbumin, in combination with C-reactive protein, are often used to evaluate nutritional status; however, they appear to be more correlative as surrogate markers for disease severity and predictors of operative morbidity and mortality.…”

Peri-operative mortality and long-term survival after partial versus radical cystectomy for muscle invasive bladder cancer

“…Previous short-term mortality studies in RC patients are numerous and identify rates from 2.4 to 8.4% [7][8][9]. Unfortunately these rates are oftentimes assessed at different time-points after PC (e.g.…”

“…However, the potential disadvantage of RC consists of its non-negligible perioperative mortality, which may range from 2.4 to 7.9% at centers [7,8] of excellence and from 5.4 to 8.4% in the community [9][10][11]. Perioperative mortality appears lower for PC, evidenced by 1.8% in-hospital mortality after this procedure [12].…”