Preoperative Hypoalbuminemia and Development of Surgical Site Infection and Anastomotic Leakage in Emergency Colorectal Surgery

Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoper ative optimization and intervention in emergency color ectal surger ies.

Therefore, this study aimed to assess the r elationship between preoperativ e ser um albumin lev els and the dev elo p me n t o f S S I and AL in emer gency colorectal sur gery patients .Meth od s: I n this cohort study , patients who underw ent emergency colorectal surgery dur ing 17 months, w ere assessed. Albumin l e v e l w a s measur ed befor e surgery , and patients wer e followed for 1 month after surger y to identify the development of SSI and AL.

In total, 173 patients were enrolled in the study, but data analysis was performed on 170 patients. They were divided into hypoalbuminemia group (n=98, 57.6%) and non-hy poalbuminemia gr oup (n=72, 42.4%). T he mean ages of patients in each gr oup w er e 57.17±16.19 and 51.61±16.14 years old, respectively (P=0.028). The AL was observed in 4 (2.4 %) patients; 3 patients in the hypoa l bu mi n e mi a group and one patient in the non-hypoalbuminemia group (P=0.205, relative risk=2.33, 95% CI: 0.42-12.82). The SSI was observed in 13 patie nt s (7.6%) during the 1-month fol lo w-up; 8 patients (5.1%) had superficial SSI and 5 (3.2%) had deep ones. Albumin level was significantly low e r i n pat ient s with AL (2.9±0.48), co mpared to those without A L (3.6±0.7 g/dL ). M oreover, albumin level was higher in patients with SSI (3 .1 1 ±0 . 6 2) , compar ed to patients without SSI (3.6±0.7 g/dL). The incidence of complications, either AL or SSI, was significantly higher in hyp oal b um in em ia patients, compared to non-hy p o al b um i ne m i a p a t ie nts (P=0.017, Odds Ratio=4.24, 95% CI: 1.29-13.9). Adjusted OR for age was 3.82 (95% CI: 1.15-12.75, P=0.029); therefore, a 13.5% reduction in OR indicated that age is a confounding factor.

Pr eoper ative hy poalbuminemia w as significantly associated wi t h p o st-development of complications in emergenc y c ol o r e ct a l sur ger y and older age and lower preoperative albumin levels may ser ve as valuable indicators for the identification of patients at higher r isk of complications.