Effect of hypoalbuminemia on postoperative pulmonary complications after thoracoscopic anatomical lung resection: a retrospective cohort study

Objectives Anatomical segmental resection is a standard treatment for non-small cell lung cancer but frequently entails postoperative pulmonary complications (PPCs). Serum albumin level, as useful assessment of changes in nutritional status, is closely associated with postoperative outcomes. Therefore, we evaluated the impact of preoperative albuminemia level on PPCs in thoracoscopic anatomical lung resection. Methods We conducted a retrospective analysis of clinical data from 1,192 patients who underwent elective thoracoscopic anatomical lung resection owing to pulmonary tumors or other diseases at the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2020. Patients were stratified into a hypoalbuminemia group (<35 g/L) and a normal albumin group (≥35 g/L) based on the lowest albumin concentration in the 48 h before operation. Demographics, perioperative data, and PPCs incidence were compared between groups. Propensity score matching (PSM) was employed to balance baseline characteristics, after which PPCs incidence was recompared. Multivariate regression was performed to assess excess risks for PPCs associated with hypoalbuminemia, adjusted for demographics and clinical variables. Results Among the 1,192 patients included, the overall incidence rate of PPCs was 26.7% (319/1,192), with pneumonia being the most common complication (16.0%). Preoperative hypoalbuminemia was present in 224 patients (18.8%). After PSM, the hypoalbuminemia group had a significantly higher incidence of PPCs compared to the normal albumin group ( P < 0.05). Multivariate logistic regression identified hypoalbuminemia as an independent risk factor for PPCs. Additionally, patients with hypoalbuminemia had a longer postoperative hospital stay. Conclusion Preoperative hypoalbuminemia is an independent predictor of PPCs, particularly pneumonia, in patients with normal pulmonary function undergoing thoracoscopic anatomical lung resection.