Role of serum albumin and body mass index as predictors of post-operative morbidity and mortality in elective major abdominal surgeries

Vikrant M. Bhagvat; Smruti Ghetla; Tilakdas Shetty; Manish Upwanshi

doi:10.18203/2349-2902.isj20163973

Authors

Vikrant M. Bhagvat Department of General Surgery, B.Y.L. Nair Ch. Hospital and T.N. Medical College, Mumbai, Maharashtra, India
Smruti Ghetla Department of General Surgery, B.Y.L. Nair Ch. Hospital and T.N. Medical College, Mumbai, Maharashtra, India
Tilakdas Shetty Department of General Surgery, B.Y.L. Nair Ch. Hospital and T.N. Medical College, Mumbai, Maharashtra, India
Manish Upwanshi Department of General Surgery, B.Y.L. Nair Ch. Hospital and T.N. Medical College, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20163973

Keywords:

Body mass index, Mortality, Post-operative morbidity, Serum albumin

Abstract

Background:The adverse effects of malnutrition on the morbidity and mortality of patients was first recognized by Hippocrates (460 BC- 370 BC) many centuries ago. It is common and occurs in about 30% of surgical patients with gastrointestinal diseases and in up to 60% of those in whom hospital stay has been prolonged because of postoperative complications. There is a substantial evidence to show that patients who have signs of malnutrition have a higher risk of complications and an increased risk of death in comparison with patients who have adequate nutritional reserves. Nutritional assessment is essential for identifying patients who are at risk of developing complications related to significant malnutrition.

Methods: All the collected data was entered in Microsoft Excel sheet. It was then transferred to SPSS ver. 17 software for statistical analysis. Quantitative data was compared by using student’s t-test and qualitative data compared using frequency and usage. Efficacy of serum albumin and BMI as screening test to predict the occurance of complications in patients was compared using roc curve. P value of < 0.05 considered as significant.

Results:Even though body mass index was associated with postoperative complications but serum albumin was better prognostic indicator than body mass index.

Conclusions:Majority of patients had serum albumin < 2.5 gm/dl and more complications were seen with serum albumin < 3.5 gm/dl which was statistically significant (p value 0.01). Sr. albumin is a good prognostic indicator because of its ability to detect protein energy malnutrition.

Metrics

Metrics Loading ...

References

Macfie J. Nutrition and fluid therapy. Bailey and Love, Short Practice of Surgery 25th edition. CRC Press. USA. 2013: 223.

Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS. Physical Activity and Reduced Occurrence of Non-Insulin-Dependent Diabetes Mellitus. New England J Med. 1991;325:147-52.

Gibbs J1, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of mortality and morbidity : results from the National VA Surgical Risk Study Arch Surg. 1999 Jan;134(1):36-42

C.-A. Righini , N. Timi, P. Junet, A. Bertolo, E. Reyt, I. Atallah. Assesment of Nutritional Status at the time of diagnosis in patients treated for head and neck cancer

Reinhardt GF, Myscofski JW, Wilkens DB, Dobrin PB, Mangan JE, Stannard RT. Incidence and mortality of hypoalbuminemic patients in hospitalized veterans. JPEN J Parenter Enteral Nutr. 1980;4(4):357-9.

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity. Arch Surg. 1999;134:36-42.

Rady MY, Ryan T, Starr NJ. Clinical characteristics of preoperative hypoalbuminemia predict outcome of cardiovascular surgery. JPEN J Parenter Enteral Nutr. 1997;21(2):81-90.

Kudsk KA, Tolley EA, Delvitt RC, Janu PG, Blackwell AP, Kin BK et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr. 2003;27(1):19.

Luzzi FA, Sette S, Franklin M, Janes WP. A simplified approach of assessing adult chronic energy deficiency. Eur J Clin Nutr. 1992;46:173-186.

Clark RAF. Wound repair. In Clark RAF (ed): The molecular and cellular biology of wound repair, 2nd ed, New York, Plenum Press; 1996: 31.

Bhamidipati CM, Lapar DJ, Mehta GS, Kern JA, Upchurch GR, Kron IL, Ailawadi G. Albumin is a better predictor of outcomes than body mass index following coronary artery bypass grafting. Surgery. 2011;150(4):626-34.