Obstet Gynecol Sci.  2015 Sep;58(5):359-367. 10.5468/ogs.2015.58.5.359.

Preoperative hypoalbuminemia is a risk factor for 30-day morbidity after gynecological malignancy surgery

• Kim J
• Shim SH
• Oh IK
• Yoon SH
• Lee SJ
• Kim SN
• Kang SB

• KMID: 2058459
• DOI: http://doi.org/10.5468/ogs.2015.58.5.359

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.
CONCLUSION
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.

Keyword

Genital neoplasms, female; Hypoalbuminemia; Nutritional status; Postoperative complications

MeSH Terms

Ascites
Diet
Female
Genital Neoplasms, Female
Humans
Hypoalbuminemia*
Length of Stay
Medical Records
Multivariate Analysis
Nutritional Status
Postoperative Complications
Risk Factors*
Serum Albumin
Serum Albumin

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