Association between preoperative serum albumin levels and the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a single-center retrospective cohort study

Postoperative nausea and vomiting (PONV) is a common complication after laparoscopic surgery and may impair recovery. This study investigated the independent association between preoperative serum albumin (ALB) levels and PONV, and assessed the value of ALB as a preoperative predictor. In this single-center retrospective cohort study, 263 adult patients undergoing elective laparoscopic surgery at Ganzhou People's Hospital between June 2022 and May 2025 were consecutively enrolled. Patients were stratified into tertiles according to preoperative ALB levels. ROC analysis was used to determine the optimal ALB cutoff for predicting PONV, and multivariable logistic regression was performed after adjustment for potential confounders. The incidence of PONV was 45.5% in the low-ALB group, 17.2% in the middle-ALB group, and 13.6% in the high-ALB group, showing a significant inverse trend (P<0.001). Compared with the low-ALB group, the adjusted odds ratios for PONV were 0.24 (95% CI: 0.11-0.53) in the middle-ALB group and 0.21 (95% CI: 0.09-0.48) in the high-ALB group (P<0.001). ROC analysis showed that preoperative ALB had moderate predictive ability for PONV (AUC=0.792, 95% CI: 0.732-0.852), with an optimal cutoff of 37.2 g/L (sensitivity 74.6%, specificity 70.4%). Subgroup analyses showed consistent associations across sex, ASA physical status, and surgical type. Among patients with low ALB levels, female sex and total intraoperative remifentanil dose were independently associated with PONV. Preoperative hypoalbuminemia (ALB <37.2 g/L) was independently associated with increased PONV risk after laparoscopic surgery. Serum albumin may be a simple and useful marker for preoperative risk stratification and individualized prophylaxis.