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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.

PURPOSE:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSION:
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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