Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California-Los Angeles, CA. Electronic address: https://twitter.com/RussyanMabeza.
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California-Los Angeles, CA.
Surgery. 2022 Nov;172(5):1456-1462. doi: 10.1016/j.surg.2022.07.022. Epub 2022 Aug 30.
The present study examined the association of nutrition status, as defined by preoperative serum albumin, with postoperative outcomes and resource use after groin hernia repair.
The 2006 to 2019 American College of Surgeons National Surgical Quality Improvement Program database was queried for adults (≥18 years) undergoing open or laparoscopic repair of inguinal or femoral hernia. Patients were stratified based on the following preoperative serum albumin levels: <2.5 g/dL (severe hypoalbuminemia), 2.5 to <3.0 (moderate hypoalbuminemia), 3.0 to <3.5 (mild), and ≥3.5 (normal albumin). Multivariable regression models were developed to assess the association of hypoalbuminemia with outcomes of interest, including 30-day mortality, postoperative complications, length of stay, and 30-day readmission.
Of the 261,052 patients meeting inclusion criteria, 0.3% had severe, 1.1% had moderate, and 7.4% had mild hypoalbuminemia, with 91.2% classified as normal albumin. After risk adjustment, mortality risk was greater for severe (5.8%, 95% confidence interval: 4.1-7.6), moderate (4.4%, 95% confidence interval: 3.4-5.3), and mild hypoalbuminemia (1.5%, 95% confidence interval: 1.2-1.8) relative to normal albumin (0.3%, 95% confidence interval: 0.2-0.3). Decreasing serum albumin levels were associated with a stepwise increase in risk of complications, length of stay, and 30-day readmission.
Decreased preoperative serum albumin is associated with increased mortality and morbidity after open and laparoscopic groin hernia repair. Serum albumin remains a relevant predictor of postsurgical outcomes and can thus be used in shared decision-making and optimization of malnourished patients in need of groin hernia repair.
本研究调查了术前血清白蛋白定义的营养状况与腹股沟疝修补术后结局和资源利用之间的关系。
2006 年至 2019 年，美国外科医师学院国家外科质量改进计划数据库对接受开放或腹腔镜腹股沟或股疝修补术的成年人（≥18 岁）进行了查询。根据以下术前血清白蛋白水平对患者进行分层：<2.5 g/dL（严重低蛋白血症）、2.5 至 <3.0（中度低蛋白血症）、3.0 至 <3.5（轻度）和≥3.5（正常白蛋白）。建立多变量回归模型以评估低蛋白血症与感兴趣的结局（包括 30 天死亡率、术后并发症、住院时间和 30 天再入院）之间的关系。
在符合纳入标准的 261052 名患者中，0.3%患有严重低蛋白血症，1.1%患有中度低蛋白血症，7.4%患有轻度低蛋白血症，91.2%被归类为正常白蛋白。在风险调整后，严重（5.8%，95%置信区间：4.1-7.6）、中度（4.4%，95%置信区间：3.4-5.3）和轻度低蛋白血症（1.5%，95%置信区间：1.2-1.8）的死亡率风险均高于正常白蛋白（0.3%，95%置信区间：0.2-0.3）。血清白蛋白水平逐渐降低与并发症、住院时间和 30 天再入院风险的增加相关。
术前血清白蛋白降低与开放和腹腔镜腹股沟疝修补术后死亡率和发病率增加相关。血清白蛋白仍然是术后结局的一个相关预测指标，因此可用于腹股沟疝修补术的营养不良患者的决策制定和优化。
