The aim of this study was to quantify the impact of preoperative hypoalbuminemia on postsurgical morbidity and 30-day mortality among a population of women who underwent gynecologic cancer surgery. Patients undergoing nonemergent surgery for any gynecologic malignancy between January 2008 and December 2010 were identified by analysis of the National Surgical Quality Improvement Program database. To determine the critical albumin cutoff value, analysis was conducted using albumin both as a dichotomous variable (<3.5 g/dL) and as a continuous variable.
Among the 3171 patients who had nonemergent surgery for a gynecologic cancer, 2110 had preoperative albumin levels available for analysis; 279 (13.2%, 279/2110) of these patients had low albumin levels. Multivariate analysis showed that a low albumin level was associated with significantly higher odds of developing 1 or more postoperative complications (adjusted odds ratio [aOR], 2; 95% confidence interval [CI], 1.47–2.73), 3 or more complications (aOR, 4.1; 95% CI, 2.31–7.1), surgical complications (aOR, 2.39; 95% CI, 1.59–3.58), pulmonary complications (aOR, 4.06; 95% CI, 2.05–8.03), infectious complications (aOR,1.84; 95% CI, 1.26–2.69), thromboembolic complications (aOR, 2.59; 95% CI, 1.33–5.06), and a higher 30-day mortality (aOR,6.52; 95% CI, 2.51–16.95). All of the above had P < 0.0001). Subgroup analysis showed no significant difference in rate of postoperative complications between patients undergoing open surgery and those who had laparoscopic surgery. The probability of a patient experiencing 1 or more postoperative complications increased linearly with a decrease in albumin level for open surgery but not for the laparoscopic procedure. However, the likelihood of patients experiencing 3 or more complications and 30-day mortality rose sharply as soon as the albumin level fell less than 3 g/dL.
These findings indicate that a preoperative albumin level less than 3 g/dL is an independent predictor of perioperative morbidity and 30-day mortality after open surgery in a population of patients with gynecological cancer. Moreover, the data show a high probability of 3 or more complications and increased 30-day mortality with albumin levels lower than 3 g/dL. The authors suggest that the subgroup at high risk can be appropriately counseled regarding optimization of preoperative nutritional status, which may improve outcomes.
University of Wisconsin, Department of Gynecologic Oncology, Madison, WI