title: Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery.
abstract: OBJECTIVE
  To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay.
  
  
  METHODS
  The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed.
  
  
  RESULTS
  The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm; P < 0.001 and 21.9 vs 23.2 kg/m(2); P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%; P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22, 95% CI 1.17-4.23; P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.
authors.affiliation: Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Prannok Rd, Bangkok Noi, Bangkok 10700, Thailand. bolloon@hotmail.com
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
authors.forename: Darin
authors.initials: D
authors.lastname: Lohsiriwat
authors.forename: Wiroon
authors.initials: W
authors.lastname: Boonnuch
authors.forename: Vitoon
authors.initials: V
authors.lastname: Chinswangwatanakul
authors.forename: Thawatchai
authors.initials: T
authors.lastname: Akaraviputh
authors.forename: Narong
authors.initials: N
authors.lastname: Lert-Akayamanee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012004:Rectal Neoplasms / Q000150:complications* / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome