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Arch Surg. 1999 Jan;134(1):36-42.

Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study.

Author information

  • 1Cooperative Studies Program Coordinating Center, the Edward Hines, Jr, VA Hospital, Hines, Ill 60141-5151, USA. jgibbs@nwu.edu

Abstract

OBJECTIVE:

To improve the precision and reliability of estimates of the association between preoperative serum albumin concentration and surgical outcomes.

DESIGN:

Prospective observational study. Patients were followed up for 30 days postoperatively. Multiple logistic regression models were developed to evaluate serum albumin level as a predictor of operative mortality and morbidity in relation to 61 other preoperative patient risk variables.

SETTING:

Forty-four tertiary care Veterans Affairs (VA) medical centers.

PATIENTS:

A total of 54215 major noncardiac surgery cases from the National VA Surgical Risk Study.

MAIN OUTCOME MEASURES:

Thirty-day operative mortality and morbidity.

RESULTS:

A decrease in serum albumin from concentrations greater than 46 g/L to less than 21 g/L was associated with an exponential increase in mortality rates from less than 1% to 29% and in morbidity rates from 10% to 65%. In the regression models, albumin level was the strongest predictor of mortality and morbidity for surgery as a whole and within several subspecialties selected for further analysis. Albumin level was a better predictor of some types of morbidity, particularly sepsis and major infections, than other types.

CONCLUSIONS:

Serum albumin concentration is a better predictor of surgical outcomes than many other preoperative patient characteristics. It is a relatively low-cost test that should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes, particularly in populations in whom comorbid conditions are relatively frequent.

Comment in

PMID:
9927128
[PubMed - indexed for MEDLINE]
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