title: Preoperative hypoalbuminemia is associated with adverse outcomes after ileoanal pouch surgery.
abstract: BACKGROUND
  This study examines the association between preoperative albumin and ileoanal pouch (IPAA) outcomes and the utility of serum albumin in the decision to perform a staged IPAA with an initial subtotal colectomy.
  
  
  METHODS
  From 2001-2009, patients were identified from an institutional pouch database and albumin values were extracted from the clinic data repository. Hypoalbuminemic (albumin <3.5 g/dL) patients were compared with patients with normal albumin. The primary outcome was pouch failure. Secondary outcomes were anastomotic leak, length of stay, function, and quality of life after pouch surgery.
  
  
  RESULTS
  Out of 405 patients, 34 were hypoalbuminemic pre-IPAA. Pre-IPAA hypoalbuminemia was associated with pouch failure (P = 0.004). Pre-IPAA hypoalbuminemia was an independent predictor of anastomotic leak (P = 0.017). Pre-IPAA hypoalbuminemia was an independent predictor of prolonged length of stay (LOS) (P < 0.001). Hypoalbuminemic patients who underwent index total proctocolectomy (TPC) with IPAA vs. subtotal colectomy (STC) and delayed IPAA had increased perioperative transfusion (P = 0.03) and median LOS at IPAA (P = 0.002).
  
  
  CONCLUSIONS
  Preoperative serum albumin is an easily available, inexpensive marker in risk stratifying patients undergoing ileoanal pouch surgery. Serum albumin may provide an objective indicator in supporting the decision to undertake a subtotal colectomy as a first step rather than total proctocolectomy with immediate pouch creation.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: Pasha J
authors.initials: PJ
authors.lastname: Nisar
authors.forename: Kweku A
authors.initials: KA
authors.lastname: Appau
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology*; D003082:Colectomy; D003092:Colitis / Q000601:surgery*; D039021:Colonic Pouches / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D034141:Hypoalbuminemia / Q000175:diagnosis / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D011300:Preoperative Care; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012709:Serum Albumin