INTRODUCTION: Albumin is the most abundant plasma protein in humans, accounting for approximately 50%–65% of total serum protein. Albumin has been used as a marker for nutritional status, though its levels can be influenced by factors such as inflammatory activity. Serum albumin levels below 3.5 g/dL define hypoalbuminemia. Previous studies have identified low serum albumin as a risk factor for postoperative complications and mortality in outpatient surgeries. Additionally, previous studies have shown that hypoalbuminemia is associated with adverse postoperative outcomes, including surgical site infections and delayed wound healing in abdominal surgery. Therefore, preoperative assessment of albumin is essential for surgical risk stratification. Multiple studies across various surgical disciplines have yielded similar results, although this has been rarely investigated in healthy patients undergoing benign gynecological surgeries, such as hysterectomy. OBJECTIVE: This study aims to investigate the correlation between preoperative serum albumin levels and postoperative wound complications in patients undergoing benign hysterectomy. We hypothesize that preoperative hypoalbuminemia is associated with postoperative wound complications in healthy patients undergoing benign hysterectomy. METHODS: This is a retrospective cohort study of patients who underwent hysterectomy for benign gynecological reasons, with preoperative albumin levels drawn within three months of surgery between June 1, 2021, and May 31, 2025. We compared postoperative complications between patients with and without hypoalbunemia. The primary outcome was to evaluate the predictive role of preoperative serum albumin levels on postoperative complications categorized by Clavien–Dindo classification (CDC). Appropriate parametric or non-parametric tests were used to identify associations between several outcomes and patients with either low (≤3.5) or normal (>3.5) preoperative albumin levels. RESULTS: Patient data, including preoperative medical conditions, albumin levels, postoperative infections, surgical dehiscence, and reoperation, were collected within a healthcare system. Checking albumin is not a routine preoperative practice. A total of 374 patients who underwent hysterectomy for benign reasons had preoperative serum albumin levels collected. Patients had a mean age of 49.2 (SD 12.4), a BMI of 32.8 (SD 8.7), and 11% identified as current smokers. A total of 271 (72.4%) patients underwent abdominal hysterectomy, 103 (27.6%) underwent vaginal hysterectomy, and laparoscopic hysterectomy data are forthcoming. A total of 22 patients (5.8%) experienced superficial surgical site infections, 14 (3.7%) deep surgical site infections, 13 (3.5%) superficial wound dehiscence, and 9 (2.4%) underwent reoperation. Preoperative hypoalbunemia levels were statistically significantly associated with p values of <0.001, 0.005, 0.011, and 0.003, respectively. Preoperative serum albumin levels were not significantly associated with postoperative fascial dehiscence. CONCLUSIONS: Albumin levels serve as a surrogate measure of patient nutrition and have been associated with surgical outcomes in various specialties, although they are rarely studied in benign gynecology. In this study, we showed that preoperative hypoalbuminemia is a risk factor for postoperative surgical complications, including postoperative superficial and deep tissue infection, wound dehiscence, and return to the operating room. Preoperative serum albumin levels effectively predict surgical outcomes after hysterectomy. It serves as a valuable, cost-effective risk predictor that warrants further exploration for integration into preoperative assessments and patient counseling regarding surgical outcomes.
Sullivan et al. (Fri,) studied this question.
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