Department of Surgery, Division of Colon and Rectal Surgery, The George Washington University, Washington, DC, USA.
Department of Surgery, Division of Colon and Rectal Surgery, The George Washington University, Washington, DC, USA.
Clin Nutr. 2017 Oct;36(5):1333-1338. doi: 10.1016/j.clnu.2016.08.023. Epub 2016 Aug 31.
BACKGROUND & AIMS: The National Veterans' Affairs Surgical Risk Study identified preoperative hypoalbuminemia as an independent risk factor for postoperative morbidity and mortality. Since that time, few studies have investigated the use of preoperative markers as tools to risk stratify colon cancer patients. The purpose of our study is to determine if there is an association between preoperative hypoalbuminemia and 30-day patient morbidity and mortality in colon cancer patients using the Targeted-Colectomy American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP).
Stage I, II, and III elective colon resections with ileocolostomy or colocolostomy were identified within the ACS-NSQIP targeted colectomy database from 2012 through 2013. Hypoalbuminemia was defined as albumin <3.5 g/dL. Patients with hypoalbuminemia were compared to those with a normal albumin level in terms of 30-day morbidity and mortality. The albumin level at which point 30-day morbidity and mortality increased was identified.
A total of 5143 patients met inclusion criteria; 4397 (85.5%) patients had a normal albumin level while 746 (14.5%) had hypoalbuminemia. Preoperative hypoalbuminemia significantly increased the risk of 30-day mortality (p < 0.0001). The association of hypoalbuminemia with 30-day outcomes was more significant in patients who underwent open surgery and had an intra-abdominal anastomosis. The risk of an adverse event was observed to increase at an albumin level ≤3.1 g/dL.
Preoperative hypoalbuminemia is associated with an increased risk of early patient morbidity and mortality in patients undergoing surgery for colon cancer. Preoperative optimization of this patient population warrants further investigation in order to prevent delay from surgical intervention to adjuvant therapy.
国家退伍军人事务部外科风险研究确定术前低白蛋白血症是术后发病率和死亡率的独立危险因素。从那时起，很少有研究调查术前标志物作为工具来对结肠癌患者进行风险分层。我们的研究目的是确定在使用美国外科医师学会国家手术质量改进计划（ACS-NSQIP）的靶向结肠切除术数据库中，术前低白蛋白血症与结肠癌患者 30 天患者发病率和死亡率之间是否存在关联。
在 2012 年至 2013 年期间，在 ACS-NSQIP 靶向结肠切除术数据库中确定了 I 期、II 期和 III 期择期结肠切除术，带有回肠结肠造口术或结肠结肠造口术。低白蛋白血症定义为白蛋白 <3.5 g/dL。将低白蛋白血症患者与白蛋白水平正常的患者进行 30 天发病率和死亡率的比较。确定白蛋白水平升高时 30 天发病率和死亡率增加的点。
共有 5143 例患者符合纳入标准；4397 例（85.5%）患者白蛋白水平正常，746 例（14.5%）患者低白蛋白血症。术前低白蛋白血症显著增加 30 天死亡率的风险（p < 0.0001）。低白蛋白血症与 30 天结果的关联在接受开放性手术和腹部内吻合术的患者中更为显著。在白蛋白水平 ≤3.1 g/dL 时观察到不良事件的风险增加。
术前低白蛋白血症与接受结肠癌手术的患者早期发病率和死亡率增加相关。需要进一步研究术前优化这一患者群体，以防止手术干预到辅助治疗的延迟。
