Preoperative Serum Albumin Level as a Predictor of Abdominal Wound-Related Complications After Emergency Exploratory Laparotomy

Abstract

BackgroundSerum albumin is generally considered to be a predictor of patients' nutritional status. Previous studies have used serum albumin to assess postoperative morbidity, mortality, and various other surgical outcomes in cardiac surgeries and elective gastrointestinal surgeries. In this study, we used preoperative serum albumin levels to assess postoperative surgical site wound complications in patients who underwent emergency exploratory laparotomy. MethodologyPreoperative serum albumin level was observed in 60 patients who underwent emergency exploratory laparotomy due to various pathological conditions and were divided into those with hypoalbuminemia (serum albumin level <3.5 g/dl and >3.5 g/dL). Postoperative surgical site infections, wound dehiscence, and various complications, such as duration of hospital stay, prolonged ileus, the incidence of enterocutaneous fistula, the incidence of anastomotic leak, and 30-day mortality, were assessed. ResultsIn our study, about 65% of the patients had hypoalbuminemia. Among them, 56.4% of the patients had surgical site infections according to the Southampton grade, with a statistically significant p-value of <0.001. Moreover, 87.2% of the patients had wound dehiscence according to the World Union Wound Healing Societies Surgical Wound Dehiscence wound grading, with a statistically significant p-value of <0.001. In addition, statistical significance was noted between preoperative hypoalbuminemia and increased postoperative hospital stay, with a p-value of <0.001. ConclusionsPreoperative serum albumin value is a formidable predictor of postoperative surgical site infections, wound dehiscence, and duration of hospital stay in patients who underwent emergency exploratory laparotomy.

Can Preoperative Laboratory Values Predict Short-term Postoperative Complications and Health Utilization in Patients Undergoing Cranioplasty?

“…Albumin cutoff values of ≤3.5 g/dL and ≤3.9 g/dL were found to be predictive of medical complications and eLOS, respectively. The reference range for albumin is 3.5 g/dL to 5.0 g/dL which coincides with our identified albumin cutoff for medical complications and the threshold other studies have used to define hypoalbuminemia in previous surgical outcomes studies 24–26 . Hematocrit cutoff values of ≤37.3% and ≤39.0% were predictive of medical complications and eLOS in male patients which is below the reference range of 40% to 54% hematocrit in men 19 .…”

“…The reference range for albumin is 3.5 g/dL to 5.0 g/dL which coincides with our identified albumin cutoff for medical complications and the threshold other studies have used to define hypoalbuminemia in previous surgical outcomes studies. [24][25][26] Hematocrit cutoff values of ≤ 37.3% and ≤ 39.0% were predictive of medical complications and eLOS in male patients which is below the reference range of 40% to 54% hematocrit in men. 19 Moreover, hematocrit threshold values of ≤ 35.5% and ≤ 37.2% demonstrated predictive capabilities for medical complications and eLOS in female patients.…”

“…Previous research, in other patient cohorts, has shown that low levels of serum albumin predispose patients to poor outcomes. One study conducted by Rohith et al 26 analyzed patients undergoing emergency exploratory laparotomy and found that low preoperative serum albumin levels, defined by a serum albumin level of <3.5 g/dL, were associated with increased wound complications and lengthened postoperative hospital stay. Dunne et al used the NSQIP database and found that lower preoperative serum albumin increased the odds of postoperative wound infections and prolonged LOS in patients undergoing abdominal wall hernia repairs 22 .…”

Entero-Cutaneous and Entero-Atmospheric Fistulas: Insights into Management Using Negative Pressure Wound Therapy

“…Hypoalbuminemia (albumin < 3.5 g per 100 mL) is most commonly associated with fistula formation [ 32 , 97 ]. Patients with hypoalbuminemia have increased morbidity and mortality rates associated with fistula formation [ 98 ].…”

Development and internal validation of a clinical prediction model for serious complications after emergency laparotomy

“…Low serum albumin level has been repeatedly and strongly associated with mortality after EL in several previous studies [ 13 ]. In a recent study of the association between albumin and wound-related complications in EL, hypoalbuminemia (serum albumin < 3.5 g/dl) correlated with increased risks of surgical site infections, wound dehiscence and increased LOS [ 30 ]. In the emergency setting, albumin has been used as a predictor of perioperative mortality for the calculation of the Emergency Acuity Surgery Score [ 31 ], and has been incorporated as a predictor of several other outcomes in the POTTER model [ 8 ].…”