Key result
Preoperative serum albumin level < 3.5 gm/dl was associated with a significantly higher rate of postoperative morbidity (48% vs 20%) compared to levels ≥ 3.5 gm/dl in patients undergoing valve replacement surgery.
Why the study?
Preoperative serum albumin level could potentially be used to upgrade risk models without extra financial burden, but its role in predicting morbidity and mortality after valve replacement surgery required evaluation.
Does preoperative low serum albumin level (< 3.5 gm/dl) predict increased morbidity and mortality in patients undergoing valve replacement surgery?
Cross-Sectional (n=50)
No
Does preoperative low serum albumin level (< 3.5 gm/dl) predict increased morbidity and mortality in patients undergoing valve replacement surgery?
Preoperative hypoalbuminemia (<3.5 gm/dl) is a significant predictor of increased postoperative morbidity, prolonged ICU stay, and longer hospital stay following valve replacement surgery.
Hypoalbuminemia may flag higher morbidity risk after valve replacement; cross-sectional data leaves open whether optimization improves outcomes.
Background Serum albumin has a close correlation with degree of malnutrition which is associated with poor outcome and quality of life after cardiac surgery. Hypoalbuminemia is associated with increased wound infection, prolonged hospital stay and death after major surgery. Hence, preoperative serum albumin level can be utilized to upgrade risk models which will further benefit the cardiac surgical patients without extra financial burden. Objective of this study was to evaluate the role of serum albumin as a predictor of morbidity and mortality after valve replacement surgery. Methods This comparative cross-sectional study was carried out at the department of cardiac surgery in BSMMU. The study population was 50, with two groups having 25 patients each. Grouping of patients were done with respect to a preset cut off value for serum albumin. The period of study was from August, 2018 to February, 2020 and purposive sampling method was applied for this study. Data was collected by using a standardized semi-structured questionnaire and face to face interview. Results By demographic characteristics, mean age was significantly higher in group B (49.96±8.69 years) than in group A (41.60±11.16 years) (p=0.005). Mean BMI was lower in group B (20.88±3.71 kg/m 2 ) than in group A (22.26±1.67 kg/m 2 ), which was found statistically significant (p=0.006). In terms of postoperative outcome, total chest drain collection was significantly higher in group B (968.80±183.49 ml) than in group A (816.00±113.40 ml), (p=0.001). Duration of ICU stay were significantly longer in group B (4.60±0.76 days) than in group A (3.92±0.86 days) (p=0.005). Similarly, duration of hospital stay was significantly longer in group B (9.88±1.56 days) than in group A (8.64±0.81 days) (p=0.001). Overall morbidity was significantly higher in group B (48%) than in group A (20%) (p<0.05). Mortality rate was higher in group B (12%) than in group A (4%), but that was not found statistically significant (p>0.05). Pearson co-efficient correlation test showed strong inverse relationship of serum albumin with total chest drain, ICU stay and hospital stay following valve replacement surgery (r= −0.473, r= −0.448 & r= −0.487 respectively), which was most significant than age and BMI (p≤0.001). Multivariate logistic regression analysis was done to assess the predictive value of serum albumin level, age and BMI, where preoperative serum albumin level was found to be the most valuable predictor of postoperative morbidity after valve replacement surgery (B= −2.251, OR 0.105, 95% CI 0.011-0.986, p<0.05). Conclusion This study demonstrated that preoperative low serum albumin level is associated with increased morbidity and mortality after valve replacement surgery. Hence, preoperative serum albumin level can be used as a reliable predictor of postoperative outcome following valve replacement surgery.
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Mozumder et al. (2020) conducted a cross-sectional in Valvular heart disease requiring valve replacement surgery (n=50). Preoperative serum albumin < 3.5 gm/dl vs. Preoperative serum albumin ≥ 3.5 gm/dl was evaluated on Postoperative morbidity (OR 0.105, 95% CI 0.011-0.986, p=0.049). Preoperative serum albumin level < 3.5 gm/dl was associated with a significantly higher rate of postoperative morbidity (48% vs 20%) compared to levels ≥ 3.5 gm/dl in patients undergoing valve replacement surgery.
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