Background: Hypoalbuminemia is a condition where the albumin level is less than 3.5 mg/dl and has been indicated as one of the determinants to post-surgery complications among surgical patients. Especially for patients with digestive system disorders and required laparotomy may need more attention for the albumin level. However, limited studies have been conducted to examine the relationship between hypoalbuminemia and post-surgery conditions among laparotomy patients.
Purpose: This pilot study was designed to examine the correlation between pre-surgery hypoalbuminemia and post-surgery complications among patients undergoing laparotomy.
Methods: A prospective study of 35 patients with laparotomy was recruited. Data had been collected from one of the Medical Center at the southern Taiwan during the period from October 2013 to December 2013. Patients were divided into two groups which have hypoalbuminemia and non-hypoalbuminemia pre-surgery.
Results: Twenty three male (65.71%) and 12 female (34.29%) with the mean age 64 (SD = 12.82) were participated in this study. Seven patients had hypoalbuminemia pre-surgery. Age and ASA status have significantly associated with pre-surgery hypoalbuminemia conditions (p<.05). Among these 7 patients with hypoalbuminemia, 6 had post-surgery complications (85.7%, p=.001). Fever and extended length of stay post-surgery have significant association with pre-surgery hypoalbuminemia (p<.05).
Conclusion/Implication for Practice: Hypoalbuminemia pre-surgery may increase the risk of post-surgery complications with patients undergoing laparotomy. Further study with larger sample size is suggested and the effectiveness of treating pre-surgery hypoalbuminemia also worth further investigation.

REFERENCES

Bae, H.-J., Lee, H.-J., Han, D.-S., Suh, Y.-S., Lee, Y.-H., Lee, H.-S.,…. Yang, H.-K. (2011). Prealbumin Levels as a Useful Marker for Predicting Infectious Complications After Gastric Surgery. Journal Gastrointestinal Surgery, 15, 2136–2144. doi: 10.1007/s11605-011-1719-z
Bozzettti, F., Gianotti, L., Braga, M., Di Carlo, V., & Mariani, L. (2007). Post-operative complications in gastrointestinal cancer patients: The joint role of the nutritional status and the nutritional support. Clinical Nutrition, 26, 698-709
Contributor, Lin, M. Y. C., Contributor, Liu,W. Y., Contributor, Tolan, A. M., Contributor, Armen, A., Contributor, Beverley, A. P., & Contributor, Bruce, E. S. (2011, January). Preoperative Serum Albumin but Not Prealbumin Is an Excellent Predictor of Postoperative Complications and Mortality in Patients with Castrointestinal Cancer. In Annual Scientific Meeting of Southern California Chapter of the American College of Surgeon, Santa Clara, California.
Daly, J. M., Fry, W. A., Little, A. G., Winchester, D. P., McKee, R. F., Stewart, A. K., & Fremgen, A. M. (2000). Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study. Journal of the American College of Surgeons, 190, 562-572.
Fabiny, A. R., & Kiel, D. P. (1997). Assessing and treating weight loss in nursing home patients. Clinical Geriatric Medicine, 13, 737-751.
Fleck, A., Raines, G., Hawker, F., Trotter, J., Wallace, P. I., Ledingham, I. M., & Calman, K. C. (1985). Increased vascular permeability. Major cause of hypoalbuminaemia in disease and injury. Lancet, 6, 781-784
Fevang, B. T., Fevang, J., Stangeland, Soreide, L., Svanes, K., & Viste, A. (2000). Complications and Death After Surgical Treatment of Small Bowel Obstruction. Annual Surgery, 231(4), 529-537
Gandhi, S. K., & Naunheim, K. S. (1997). Complications of transhiatal esophagectomy. Chest Surgery Clinics of North America, 7, 601-610
Garth, A. K., Newsome, C. M., Simmance, N., & Crowe, T. C. (2010). Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. Journal of Human Nutrition and Dietetics, 23, 393–401
Gibbs, J., Cull, W., Henderson, W., Daley, J., Hur, K., & Khuri, S. F. (1999). Preoperative serum albumin level as a predictor of operative mortality and morbidity. Results from the National VA Surgical Risk Study. Archive Surgery, 134, 36-42.
Gupta, D., & Lis, C. G. (2010). Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. Nutrition Journal. 9, 69.
Hennessey, D. B., Burke, J. P., Ni-Dhonochu, T., Shields, C., Winter, D. C., & Mealy, K. (2010). Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Annual Surgery, 252(2), 325-329. doi: 10.1097/SLA.0b013e3181e9819a
Higginson, I. J., & Costantini, M. (2008). Dying with cancer, living well with advanced cancer. European Journal Cancer. 44, 1414-1424.
Irvin, T. T., & Hunt, T. K. (1974). Effect of malnutrition on colonic healing. Annual Surgery. 180, 765-772.
Everhart, J. E, editor. (2008). The burden of digestive diseases in the United States. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, NIH Publication No. 09-6443 [pp. – ].
Kable, A. K., Gibberd, R. W., & Spigelman, A. D. (2002). Adverse events in surgical patients in Australia. International Journal Quality Health Care; 14: 269–76.
Kudsk, K. A., Tolley, E. A., DeWitt, R. C., Janu, P. G., Blackwell, A. P., Yeary, S., & King, B. K. (2003). Preoperative albumin and surgical site identify surgical risk for major postoperative complications. Journal Parenteral Enteral Nutrition, 27, 1–9.
Lai, C. C., You, J. F., Yeh, C. Y., Chen, J. S., Tang, R., Wang, J. Y., & ChinLai, C. C. (2011). Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. International Journal Colorectal Diseases, 26(4), 473-481. doi: 10.1007/s00384-010-1113-4
Lohsiriwat, V., Chinswangwatanakul, V., Lohsiriwat, S., Akaraviputh, T., Boonnuch, W., Methasade, A., & Lohsiriwat, D. (2008). Hypoalbuminemia is a predictor of delayed postoperative bowel function and poor surgical outcomes in right-sided colon cancer patients. World Journal Gastroenterology.
Lohsiriwat, V., Lohsiriwat, D., Boonnuch, W., Chinswangwatanakul, V., Akaraviputh, T., & Lertakayamanee, N. (2008). Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World Journal of Gastroenterology, 14(8), 1248-1251. doi: 10.3748/wjg.14.1248
Margarson, M., P., & Soni, N. (1998). Serum Albumin: touchstone or totem. Anaesthesia, 53, 789-803
Moshage, H. J., Janssen, J. A. M., Franssen, J. H., Hafkenscheid, J. C. M., & Yap, S. H. (1987). Study of the Molecular Mechanism of Decreased Liver Synthesis of Albumin in Inflammation. Journal Clinical Investigation, 79, 1635-1641.
Mulholland, M. W., & Doherty, G. M. Complications in Surgery. (Ed. 2nd). (2011). Philadelphia: Lippincott William & Wilkins.
Nicholson, J. P., Wolmarans, M. R., & Park, G. R. (2000). The role of albumin in critical illness. British Journal of Anaesthesiology, 85, 599-610
On˜ ate-Ocan˜ a, L. F., Aiello-Crocifoglio, V., Gallardo-Rinco´ n, D., Herrera-Goepfert, R., Brom-Valladares, R., Carrillo, J., . . . Mohar-Betancourt, A. (2006). Serum albumin as a significant prognostic factor for patients with gastric carcinoma. Annual Surgery Oncology, 14, 381-389
Pacelli, F., Bossola, M., Rosa, F., Tortorelli, A. P., Papa, V., & Doglietto, G. B. (2008). Is malnutrition still a risk factor of postoperative complications in gastric cancer surgery? Clinical Nutritional, 27(3), 398-407. doi: 10.1016/j.clnu.2008.03.002
Reife, C. M. (1995). Involuntary weight loss. Medical Clinics of North America, 79, 299-313.
Reynolds, J. V., Redmond, H. P., Ueno, N., Steigman, C., Ziegler, M. M., Daly, J. M., & Johnston, R. B. (1992). Impairment of macrophage activation and granuloma formation by protein deprivation in mice. Cell Immunology, 139, 493-504
Rivadeneira, D. E., Grobmyer, S. R., Naama, H. A., Mackrell, P. J., Mestre, J. R., Stapleton, P. P., & Daly, J. M. (2001). Malnutrition-induced macrophage apoptosis. Surgery, 129, 617-625
Robin. (2012). Surgery Statistics. Retrieved from http://www.reportlinker.com/p0536561-summary/Epidemiology-Major-Abdominal-Surgery-A-key-risk-factor-for-deep-vein-thrombosis-and-pulmonary-embolism.html
Ryan, A. M., Hearty A., Prichard, R. S., Cunningham, A., Rowley, S. P., & Reynolds, J. V. (2007). Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy. Journal Gastrointestinal Surgery, 11, 1355-1360. doi: 10.1007/s11605-007-0223-y
Sah, B. K., Zhu, Z. G., Wang, X. Y., Yang, Q. M., Chen, M. M., Xiang, M.,…Yan, M. (2009). Post-operative complications of gastric cancer surgery: female gender at high risk. European Journal of Cancer Care,18, 202–208
Scheidegger, A., Lundsgaard, H. P., Kupfer, K., & Stirnemann, H. (1979). Hypoproteinemia causing postoperative interstitial paralytic ileus. Chirugical Surgery, 50, 16-20.
Sungurtekin, H., Sungurtekin, U., Balci, C., Zencir, M., & Erdem, E. (2004). The influence of nutritional status on complications after major intraabdominal surgery. Journal American College of Nutrition, 23, 227–232.
Surgery Statistics-Disease and condition. (2013). Beaumont health system. Retrieved from http://www.beaumont.edu/health-library/P01412 on November 12th
Testini, M., Margari, A., Amoruso, M., Lissidini, G., & Bonomo, G. M. (2000). The dehiscence of colorectal anastomosis: the risk factors. Annual Italia Chiri,71, 433-440.
Urschel, J. D. (1995). Esophagogastrostomy anastomotic leak rates complicating esophagectomy: A review. American Journal of Surgery, 169, 634-640
Vincent, J. L., Dubois, M. J., Navickis, R. J., & Wilkes, M. M. (2003). Hypoalbuminemia in Acute Illness: Is There a Rationale for Intervention? A Meta-Analysis of Cohort Studies and Controlled Trials. Annals of Surgery. 237(3), 319–334. doi: 10.1097/01.SLA.0000055547.93484.87
Ward, M. W. , Danzi, M., Lewin, M. R., Rennie, M. J., & Clark, C. G. (1982). The effects of subclinical malnutrition and re-feeding on the healing of experimental colonic anastomoses. British Journal Surgery, 69, 308-310
Weiser, T. G., Makary, M. A., Haynes, A. B., Dziekan, G., Berry, W. R., & Gawande, A. A. (2009). Standardised metrics for global surgical surveillance. Lancet. 374, 1113-1117
Weiser, T. G., Regenbogen, S. E., Thompson, K. D., Haynes, A. B., Lipsitz, S. R., Berry, W. R., & Gawande, A. A. (2008). An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet. 372, 139-144
Zullo, F., Palomba, S., Russo, T., Falbo, A., Costantino, M., Tolino, A., . . . Venuta, S. (2005). A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: A focus on the quality of life. American Journal of Obstetrics and Gynecology. 193, 1344–1352.