蛋白质作为术前预测指标——低蛋白血症对乳房缩小手术30天预后的影响。

Protein as a preoperative predictor - Impact of hypoalbuminemia on 30-day outcomes of breast reduction surgery.

作者信息

Knoedler Samuel, Klimitz Felix J, Diatta Fortunay, Perozzo Filippo A G, Sofo Giuseppe, Alfertshofer Michael, Cherubino Mario, Mayer Horacio, Panayi Adriana C, Kim Bong-Sung, Pomahac Bohdan, Kauke-Navarro Martin

机构信息

Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.

Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic, and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.

出版信息

J Plast Reconstr Aesthet Surg. 2025 Jan;100:144-152. doi: 10.1016/j.bjps.2024.11.011. Epub 2024 Nov 20.

DOI:10.1016/j.bjps.2024.11.011

PMID:39615141

Abstract

BACKGROUND

Hypoalbuminemia, a biomarker of malnutrition, has been associated with adverse surgical outcomes;, however, its impact on breast reduction surgery is not yet well-documented.

METHODS

We queried the American college of surgeons national surgical quality improvement program database to identify patients who underwent breast reduction surgery between 2008 and 2022. Patients were grouped by preoperative normal albumin levels (≥3.5 g/dL) and hypoalbuminemia (<3.5 g/dL). Preoperative, intraoperative, and 30-day postoperative outcomes, including complications and readmissions, were compared using the univariate tests and multivariable logistic regression.

RESULTS

We included a total of 7277 cases, among whom 96% (n = 6964) had normal albumin values and 4% (n = 298) had hypoalbuminemia (n = 298). Patients with hypoalbuminemia showed a significantly higher body mass index (37.1 ± 8.1 vs. 33.3 ± 6.3 kg/m², p < 0.001) and were more likely to be Black or African American (49.0 vs. 27.8%, p < 0.001). Comorbidities such as diabetes (14.7 vs. 7.4%, p < 0.001), chronic obstructive pulmonary disease (4.0 vs. 1.0%, p < 0.001), and hypertension (35.2 vs. 26.3%, p = 0.002) were significantly more prevalent in the hypoalbuminemia group. Hypoalbuminemia was associated with a significantly increased risk of complications (13.8 vs. 6.1%, p < 0.001), with higher rates of superficial incisional infections (7.0 vs. 2.6%, p = 0.001) and unplanned readmissions (3.4 vs. 1.4%, p = 0.05). Multivariable analysis confirmed hypoalbuminemia as an independent predictor of postoperative complications (OR 1.96, p = 0.001), medical complications (OR 2.62, p = 0.02), and surgical complications (OR 1.91, p = 0.02).

CONCLUSION

Hypoalbuminemia significantly raises the risk of 30-day postoperative complications in breast reduction surgery. Preoperative nutritional assessment and optimization are crucial in improving surgical outcomes, particularly in patients with high body mass index and comorbidities.

摘要

背景

低蛋白血症是营养不良的生物标志物，与不良手术结局相关；然而，其对缩乳手术的影响尚未得到充分记录。

方法

我们查询了美国外科医师学会国家外科质量改进计划数据库，以确定2008年至2022年间接受缩乳手术的患者。患者按术前白蛋白水平正常（≥3.5g/dL）和低蛋白血症（<3.5g/dL）分组。使用单因素检验和多变量逻辑回归比较术前、术中和术后30天的结局，包括并发症和再入院情况。

结果

我们共纳入7277例病例，其中96%（n = 6964）白蛋白值正常，4%（n = 298）为低蛋白血症（n = 298）。低蛋白血症患者的体重指数显著更高（37.1±8.1 vs. 33.3±6.3kg/m²，p < 0.001），更有可能是黑人或非裔美国人（49.0% vs. 27.8%，p < 0.001）。糖尿病（14.7% vs. 7.4%，p < 0.001）、慢性阻塞性肺疾病（4.0% vs. 1.0%，p < 0.001）和高血压（35.2% vs. 26.3%，p = 0.002）等合并症在低蛋白血症组中显著更常见。低蛋白血症与并发症风险显著增加相关（13.8% vs. 6.1%，p < 0.001），浅表切口感染率更高（7.0% vs. 2.6%，p = 0.001）和计划外再入院率更高（3.4% vs. 1.4%，p = 0.05）。多变量分析证实低蛋白血症是术后并发症（OR 1.96，p = 0.001）、医疗并发症（OR 2.62，p = 0.02）和手术并发症（OR 1.91，p = 0.02）的独立预测因素。