title: Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery.
abstract: OBJECTIVE
  To determine the relationship between preoperative hypoalbuminemia and the development of complications after gynecological cancer surgery, as well as postoperative bowel function and hospital stay.
  
  
  METHODS
  The medical records of 533 patients with gynecological cancer surgery at Konkuk University Hospital between 2005 and 2013 were reviewed. Serum albumin level <3.5 g/dL was defined as hypoalbuminemia. All perioperative complications within 30-days after surgery, time to resumption of normal diet and length of postoperative hospital stay, were analyzed. Regression models were used to assess predictors of postoperative morbidity.
  
  
  RESULTS
  The median age was 49 years (range, 13 to 85 years). Eighty patients (15%) had hypoalbuminemia. Hypoalbuminemic patients had significantly higher consumption of alcohol >2 standard drinks per day, lower American Society of Anesthesiologist score, higher frequency of ascites, and more advanced stage compared with non-hypoalbuminemic patients. Overall complication rate within 30-days after surgery was 20.3% (108 out of 533). Hypoalbuminemic patients were more likely to develop postoperative complications compared to non-hypoalbuminemic patients (34.3% vs. 17.8%, P=0.022), and had significantly longer median time to resumption of normal diet (3.3 [1-6] vs. 2.8 [0-15] days, P=0.005) and length of postoperative hospital stay (0 [7-50] vs. 9 [1-97] days, P=0.014). In multivariate analysis, age >50 (odds ratio [OR], 2.478; 95% confidence interval [CI], 1.310 to 4.686; P=0.005), operation time (OR, 1.006; 95% CI, 1.002 to 1.009; P=0.006), and hypoalbuminemia (OR, 2.367; 95% CI, 1.021 to 5.487; P=0.044) were the significant risk factor for postoperative complications.
  
  
  CONCLUSIONS
  Preoperative hypoalbuminemia in patients with elective surgery for gynecologic malignancy is an independent predictor of 30-days postoperative complications. Identification of this subset and preoperative optimization of nutritional status may improve surgical outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Seung-Hyuk
authors.initials: SH
authors.lastname: Shim
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: In-Kyoung
authors.initials: IK
authors.lastname: Oh
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sang-Hee
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sun-Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Soo-Nyung
authors.initials: SN
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Soon-Beom
authors.initials: SB
authors.lastname: Kang
keywords: Genital neoplasms, female; Hypoalbuminemia; Nutritional status; Postoperative complications