title: Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies.
abstract: OBJECTIVE
  To quantify the impact of preoperative hypoalbuminemia on 30-day mortality and morbidity after gynecologic cancer surgery.
  
  
  METHODS
  Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent any non-emergent surgery for gynecologic malignancy between 1/1/2008 and 12/31/2010 were identified. Analysis was conducted with albumin both as a dichotomous variable (<3.5 g/dl was defined as low albumin) and as a continuous variable to determine a clinically relevant cut-off value.
  
  
  RESULTS
  Of the total 3171 patients identified, 2110 had preoperative albumin levels available for analysis. In addition, 279 (13.3%) of these patients had low albumin levels. According to multivariate analysis, the low albumin group had significantly higher odds of developing one or more post-operative complications (OR-2,CI: 1.47-2.73, p<0.0001), three or more complications (OR-4.1,CI: 2.31-7.1, p<0.0001), surgical complications (OR-2.39,CI: 1.59-3.58, p<0.0001), thromboembolic complications (OR-2.59,CI: 1.33-5.06, p<0.0001), pulmonary complications (OR-4.06,CI: 2.05-8.03, p<0.0001), or infectious complications (OR-1.84,CI: 1.26-2.69, p<0.0001) and a higher 30-day mortality (OR-6.52,CI: 2.51-16.95, p<0.0001). Upon subgroup analysis, this difference was not found in patients undergoing laparoscopic surgery. In patients undergoing open surgery, the probability of experiencing one or more post-operative complications increased linearly with the decrease in albumin level; however, the probability of patients experiencing three or more complications and 30-day mortality increased sharply as soon as the albumin level decreased below 3g/dl.
  
  
  CONCLUSIONS
  Preoperative albumin levels <3g/dL identify a population of patients at a very high-risk of experiencing perioperative morbidity and 30-day mortality after open surgery.
authors: University of Wisconsin, Department of Gynecologic Oncology, Madison, WI, USA. Electronic address: uppal@gmail.com.
authors: Shitanshu
authors: S
authors: Uppal
authors: Ahmed
authors: A
authors: Al-Niaimi
authors: Laurel W
authors: LW
authors: Rice
authors: Stephen L
authors: SL
authors: Rose
authors: David M
authors: DM
authors: Kushner
authors: Ryan J
authors: RJ
authors: Spencer
authors: Ellen
authors: E
authors: Hartenbach
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D034141:Hypoalbuminemia / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D057234:Preoperative Period; D011379:Prognosis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Albumin; Gynecologic oncology; NSQIP; Nutritional status; Postoperative complications; Surgical outcomes