December 14, 2022Annals of SurgeryOpen Access

Intraoperative Use of Albumin in Major Noncardiac Surgery: Incidence, Variability, and Association With Outcomes

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Why the study?

The impact of albumin use during major surgery is unknown, and a lack of evidence in major noncardiac surgery has precluded standardization in clinical guidelines.

Does intraoperative albumin administration affect postoperative outcomes in adult patients undergoing major noncardiac surgery?

Structured PICO

Does intraoperative albumin administration affect postoperative outcomes in adult patients undergoing major noncardiac surgery?

Population

614,215 adult patients undergoing major noncardiac surgery under general anesthesia across 54 U.S. hospitals between January 2014 and June 2020. Exclusions included preoperative End Stage Renal Disease (eGFR <15 mL/min/1.73 m2), ASA physical status 6, repeat surgery within 30 days, and cardiac, obstetric, neurosurgical, or liver transplant cases.

Intervention

Intraoperative intravenous albumin administration (predominantly 5% iso-oncotic solution, median volume 250 mL).

Comparator

No intraoperative albumin administration (albumin-unexposed cases), compared within a propensity score-matched cohort (n=153,218).

Outcome

Incidence of albumin administration.hard clinical

Intraoperative albumin administration during major noncardiac surgery is associated with an increased risk of postoperative complications, including acute kidney injury and 30-day mortality.

Limitations

Observational retrospective design
Potential residual confounding despite propensity score matching and instrumental variable estimator approach
Missing data requiring exclusion of observations

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Should not yet change practice; leaves open whether albumin causes harm amid wide unexplained institutional variation.

Cite This Study

Lazzareschi et al. (2022) studied this question.

synapsesocial.com/papers/6a801decbb077c030dcab325 https://doi.org/10.1097/sla.0000000000005774

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Ask AI

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Intraoperative Use of Albumin in Major Noncardiac Surgery: Incidence, Variability, and Association With Outcomes

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Intraoperative Use of Albumin in Major Noncardiac Surgery: Incidence, Variability, and Association With Outcomes

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider