Bendersky Victoria, Sun Zhifei, Adam Mohamed A, Rushing Christel, Kim Jina, Youngwirth Linda, Turner Megan, Migaly John, Mantyh Christopher R
Duke University School of Medicine, Durham, NC, USA.
Department of Surgery, Duke University, Durham, NC, USA.
J Gastrointest Surg. 2017 Apr;21(4):692-699. doi: 10.1007/s11605-017-3370-9. Epub 2017 Jan 30.
Hypoalbuminemia is associated with adverse surgical outcomes. A minimum threshold and the impact of incrementally decreasing albumin remain undefined for colorectal surgery patients.
The 2011-2013 National Surgical Quality Improvement Program (NSQIP) dataset was queried for patients undergoing elective colorectal surgery. Multivariable regression analyses with restricted cubic splines (RCS) were used to examine the adjusted association between preoperative serum albumin level and the incidence of complications and to establish an optimal threshold. RCS allows for flexible evaluation in multivariable models without having to assume a specific relationship a priori.
Sixteen thousand one hundred forty-five patients met study criteria. RCS analysis demonstrated an inflection point at serum albumin level of 3.9 mg/dL. Patients with preoperative albumin <3.9 mg/dL vs. albumin ≥3.9 mg/dL had a higher likelihood of experiencing a major complication (odds ratio (OR) = 1.18, confidence interval (CI) 1.07-1.30, p = 0.0007) or any complications (OR 1.18, CI 1.08-1.29, p = 0.0002,) and had a lengthened hospital stay (p < 0.001).
This study objectively determines that a threshold preoperative serum albumin of ≥3.9 mg/dL is associated with improved outcomes in elective colorectal surgery patients. Each 0.5 mg/dL decrease in albumin was progressively associated with increased risk for complications. Identifying a minimum albumin threshold has implications in perioperative optimization of patients undergoing colorectal surgery.
低白蛋白血症与手术不良结局相关。结直肠手术患者的最低阈值以及白蛋白水平逐渐降低的影响仍不明确。
查询2011 - 2013年国家外科质量改进计划（NSQIP）数据集，以获取接受择期结直肠手术的患者。使用带有受限立方样条（RCS）的多变量回归分析来检查术前血清白蛋白水平与并发症发生率之间的校正关联，并确定最佳阈值。RCS允许在多变量模型中进行灵活评估，而无需事先假设特定关系。
16145名患者符合研究标准。RCS分析显示血清白蛋白水平为3.9mg/dL时存在一个拐点。术前白蛋白<3.9mg/dL的患者与白蛋白≥3.9mg/dL的患者相比，发生严重并发症（优势比（OR）= 1.18，置信区间（CI）1.07 - 1.30，p = 0.0007）或任何并发症（OR 1.18，CI 1.08 - 1.29，p = 0.0002）的可能性更高，且住院时间延长（p < 0.001）。
本研究客观地确定，术前血清白蛋白阈值≥3.9mg/dL与择期结直肠手术患者的预后改善相关。白蛋白每降低0.5mg/dL，并发症风险逐渐增加。确定最低白蛋白阈值对结直肠手术患者的围手术期优化具有重要意义。
