Hypoalbuminemia Is Associated with Increase in Post-Operative Complication and Mortality Rates in Hand Surgery
Oleksandr Trofymenko, M.Ed.1, Edvin Telemi, B.S.1, Raghunandan Venkat, M.D., MPH2, Ethan Larson, M.D.2.
1University of Arizona College of Medicine - Tucson, Tucson, AZ, USA, 2University of Arizona, Department of Surgery, Tucson, AZ, USA.
Hypoalbuminemia has been used clinically as a preoperative risk factor for different surgical complications. To our knowledge, no study has looked at the impact of low albumin on hand surgery outcomes. We conducted a retrospective analysis to identify the influence of hypoalbuminemia on complications in hand surgery.
The NSQIP database was queried using CPT codes to identify 16,429 patients undergoing hand surgery from 2005 until 2012. 14.16% underwent inpatient (n = 2,326) and 85.84% outpatient (n = 14,103) surgical procedure. Hypoalbuminemia was defined as preoperative serum albumin <3.5g/dL. Previously described outcomes of overall complication rates and mortality were assessed. Univariate analysis and multivariate regression analysis accounting for demographic factors, comorbidities, and operative details were conducted.
Median age was 50 years, and BMI was 27.1Kg/m2. 51.7% of patients were females. 21.4% of patients were ASA Class 3 or higher. 2.60% (n = 427) patients were identified as hypoalbuminemic. On univariate analysis: overall complication rates increased from 1.7% to 17.6% (p<0.01) and mortality increased from 0.09% to 6.32% (p<0.01). On multivariate analysis: overall complication rate was independently predicted by hypoalbuminemia (Adjusted Odd Ratio (AOR): 1.79, p=0.016); mortality rate was also independently predicted by hypoalbuminemia (AOR: 6.39, p<0.01).
Hypoalbuminemia, detected preoperatively, significantly predicts complications and mortality after hand surgery. Independent predictive potential of albumin level on complication rates and, especially, mortality suggest that serum albumin level can be a valuable marker of increased risk and potentially identify high-risk surgical candidates.
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