Even modest hypoalbuminemia affects outcomes of colorectal surgery patients

• Modest hypoalbuminemia is a common condition in colorectal patients.
• Hypoalbuminemia can be used as a prognostic factor in colorectal surgery.
• Each unit decrease of the serum albumin level increases mortality of patients (49%).
• Each unit decrease of the serum albumin level increases morbidity of patients (24%).
• Pulmonary complications have strong associations with modest hypoalbuminemia.

BackgroundA small decrease in the serum albumin from the normal level is a common condition in preoperative laboratory tests of colorectal surgery patients; however, there is limited data examining these patients. We sought to identify outcomes of such patients.MethodsThe National Surgical Quality Improvement Program database was used to evaluate all patients who had modest levels of hypoalbuminemia (3 ≤ serum albumin < 3.5 g/dL) before colorectal resection from 2005 to 2012. Multivariate analysis using logistic regression was performed to quantify complications associated with modest hypoalbuminemia.ResultsA total of 108,898 patients undergoing colorectal resection were identified, of which 16,962 (15.6%) had modest levels of preoperative hypoalbuminemia. Postsurgical complications significantly associated (P < .05) with modest hypoalbuminemia were as follows: hospitalization more than 30 days (adjusted odds ratio [AOR], 1.77), deep vein thrombosis (AOR, 1.64), unplanned intubation (AOR, 1.42), ventilator dependency for more than 48 hours (AOR, 1.30), and wound disruption (AOR, 1.22).ConclusionsModest hypoalbuminemia is a common preoperative condition in patients undergoing colorectal resection. Our analysis demonstrates that modest hypoalbuminemia has associations with increased postoperative complications, especially pulmonary complications.