S. E. Rudasill1, Y. Sanaiha1, J. W. Antonios1, H. Khoury1, A. L. Mardock1, H. Xing1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles,Cardiac Surgery,Los Angeles, CA, USA
Introduction:
Hypoalbuminemia (serum albumin <3.5 g/dL) is associated with increased morbidity and mortality following invasive procedures. Whether this predictive value persists for less invasive laparoscopic surgery has not yet been characterized. This study examined the association of preoperative serum albumin with outcomes for laparoscopic cholecystectomy.
Methods:
This was a retrospective study of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2005-2016. All adult patients undergoing laparoscopic cholecystectomy who had a preoperative serum albumin level within two days of surgery were included. Patients were stratified by gender and albumin levels into: <3.0 g/dL (severe malnutrition), 3.0 to <3.5 (moderate malnutrition), 3.5 to <4.0 (mild malnutrition), and ≥4.0 g/dL (normal nutrition). The primary outcome was 30-day mortality. The Kruskal-Wallis and chi-squared tests were used for univariate analysis. Multivariable logistic regressions, adjusted for baseline differences, assessed the predictive value of preoperative serum albumin on mortality, septic shock, infection, readmission, and hospital length of stay (LOS).
Results:
Of 131,855 patients undergoing laparoscopic cholecystectomy, 14.0% had severe, 22.8% moderate, and 29.7% mild malnutrition, with 33.5% classified as normal nutrition. Patients with severe malnutrition were older (59.6 vs. 45.0 years, p<0.001) and more likely to have a history of diabetes (22.1 vs. 8.5%, p<0.001) and hypertension (53.1 vs. 26.7%, p<0.001) relative to those with normal nutrition. After adjustment for patient and operative characteristics, severe (OR=3.17 [2.17-4.64], p<0.001) and moderate (OR=1.82 [1.24-2.69], p=0.002) malnutrition were associated with increased mortality relative to the normally nourished cohort. Severe malnutrition was independently associated with ventilator use >48 hours (OR=3.51 [2.28-5.40], p<0.001), infection (OR=1.35 [1.14-1.59], p<0.001), and 30-day readmission (OR=1.17 [1.05-1.31], p=0.004). There was a stepwise increase in hospital LOS by serum albumin class, with an average increase of 0.9 days for moderate and 2.3 days for severe malnutrition. Female gender was independently associated with the development of septic shock in malnourished patients (Figure 1).
Conclusion:
Malnutrition, as measured by serum albumin levels, is prevalent among patients treated via laparoscopic cholecystectomy. Reduced albumin levels are strongly associated with mortality, postoperative septic shock, and increased LOS. Hypoalbuminemic patients, and particularly those with severe hypoalbuminemia <3.0 g/dL, may benefit from preoperative optimization prior to laparoscopic cholecystectomy.
