title: Determining the Optimal Quantitative Threshold for Preoperative Albumin Level Before Elective Colorectal Surgery.
abstract: Hypoalbuminemia is associated with adverse surgical outcomes. A minimum threshold and the impact of incrementally decreasing albumin remain undefined for colorectal surgery patients.
  
  
  
  The 2011-2013 National Surgical Quality Improvement Program (NSQIP) dataset was queried for patients undergoing elective colorectal surgery. Multivariable regression analyses with restricted cubic splines (RCS) were used to examine the adjusted association between preoperative serum albumin level and the incidence of complications and to establish an optimal threshold. RCS allows for flexible evaluation in multivariable models without having to assume a specific relationship a priori.
  
  
  
  Sixteen thousand one hundred forty-five patients met study criteria. RCS analysis demonstrated an inflection point at serum albumin level of 3.9 mg/dL. Patients with preoperative albumin <3.9 mg/dL vs. albumin ≥3.9 mg/dL had a higher likelihood of experiencing a major complication (odds ratio (OR) = 1.18, confidence interval (CI) 1.07-1.30, p = 0.0007) or any complications (OR 1.18, CI 1.08-1.29, p = 0.0002,) and had a lengthened hospital stay (p < 0.001).
  
  
  
  This study objectively determines that a threshold preoperative serum albumin of ≥3.9 mg/dL is associated with improved outcomes in elective colorectal surgery patients. Each 0.5 mg/dL decrease in albumin was progressively associated with increased risk for complications. Identifying a minimum albumin threshold has implications in perioperative optimization of patients undergoing colorectal surgery.
authors.affiliation: Duke University School of Medicine, Durham, NC, USA. victoria.bendersky@duke.edu.
authors.forename: Victoria
authors.identifier: 0000-0003-2214-4761
authors.initials: V
authors.lastname: Bendersky
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Sun
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Duke Department of Biostatics and Bioinformatics, Durham, NC, USA.
authors.forename: Christel
authors.initials: C
authors.lastname: Rushing
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Jina
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Youngwirth
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Turner
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: Migaly
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Mantyh
mesh_terms: D000368:Aged; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D012709:Serum Albumin
keywords: Albumin; Albumin threshold; Colorectal surgery; Patient optimization; Postoperative complications