Clinical Correlation between Preoperative Serum Albumin and Postoperative Outcome in Major Gastrointestinal Surgeries

Background: Albumin is a family of globular proteins, the most common of which are the serum albumins. All the proteins of the albumin family are water-soluble, moderately soluble in concentrated salt solutions, and experience heat denaturation. Albumins are commonly found in blood plasma and differ from other blood proteins in that they are not glycosylated. Substances containing albumins, such as egg white, are called albuminoids. It contributes to the oncotic pressure of plasma and to maintaining the distribution of extracellular fluid between the vascular and extravascular compartments. Hypoalbuminemia is associated with poor tissue healing, decreased collagen synthesis in the surgical wounds or at anastomotic sites Although it is well established that hypoalbuminemia, as a marker of malnutrition and disease, is associated with greater risk of adverse surgical outcome, previous studies have been based on relatively small samples and selected types of operations and have failed to adequately separate the predictive ability of albumin level from other risk factors. Aim of study: To determine whether preoperative serum albumin level can be used as an independent predictor of post-operative morbidity and mortality. Methods: This is a prospective comparison study conducted in general surgery department, Jubilee Mission Medical College. The source of the data will be all patients who undergo gastrointestinal surgery with resection and anastomosis in the Department of General Surgery, Jubilee Mission Medical College, Thrissur from December 2017 to May 2019. Patients are investigated preoperatively for liver function test, renal function test, thyroid function test and urine-protein creatinine ratio (obtained from urine microscopy) to rule out secondary causes of hypoalbuminemia and are classified into two groups:-normal albumin level and hypoalbuminemia. Patients with normal serum albumin level are compared with patients of low serum albumin for length of hospital stay, resumption of oral diet, surgical site infection and mortality. Results and Discussion: The preoperative albumin levels ranged from 2.1 to 3.4 g/dl with a mean value of 3.03 g/dl. In most other similar studies [1-4], a similar cut off normal range (3 or 3.5 g/dl) was assigned and patients were grouped into two based on this. To explore the possibility of using serum albumin as a simple and low-cost prognostic tool to predict the risk of adverse surgical outcomes, we used different statistical methods. Mann-Whitney U test has been performed to find out the significant role of albumin levels for length of hospital stay (Median 10.5 days and 8 days) and delay in resumption of diet (Median 5days and 3days) among two groups and it showed that there was statistically significant association with albumin levels between two groups in length of stay (p=0.021) if we classify the length of hospital stay as less than 10days and more than 10days. It is statistically significant in resumption of diet (p<0.001). There was a significant relationship found between the occurrence of surgical site infection and albumin levels.