Abstract
Objective
Our objective was to evaluate the significance of reduced preoperative albumin levels
on short-term (90-day and 1-year) mortality in patients undergoing surgery for gynaecologic
malignancy in Calgary, Alberta, Canada.
Methods
In this retrospective cohort study, patients with gynaecologic malignancies who had
surgery performed at Foothills Medical Centre in Calgary, Alberta, Canada between
January 1, 2010, and June 30, 2016, were identified. We performed univariable and
multivariable logistic regression analyses to evaluate the association between preoperative
serum albumin and 90-day and 1-year mortality. Analysis was conducted with albumin
initially as a continuous variable, and subsequently as a categorical variable after
clinically relevant threshold levels were identified.
Results
A total of 2183 patients were included in our analysis. Of the study population, 51.8%
had a preoperative serum albumin level of <35 g/L. Two critical inflection points
in mortality rate by serum albumin level were found. Mortality was significantly highest
in patients with an albumin level <20 g/L (90-day mortality 17.2%, 1-year mortality
31.9%) and next highest in patients with an albumin level of 20–25 g/L (90-day mortality
2.7%, 1-year mortality 12.0%), compared to patients with a level of >25 g/L (90-day
mortality 0.9%, 1-year mortality 3.9%). In both univariable and multivariable analyses,
preoperative hypoalbuminemia was significantly and independently associated with increased
90-day and 1-year mortality (P < 0.001).
Conclusion
Preoperative hypoalbuminemia is independently associated with increased mortality.
Patients with gynaecologic malignancies undergoing surgery and who have a preoperative
serum albumin level of <20 g/L are at a very high risk of short-term mortality.
Keywords
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Article info
Publication history
Published online: April 13, 2023
Accepted:
March 31,
2023
Received:
February 22,
2023
Footnotes
Disclosures: TK has no conflicts of interest to disclose. SG has previously received an honorarium from Astra Zeneca to present on sexual health in cancer survivors. She previously served on a GSK advisory board in 2022. QD has no conflicts of interest to disclose. KD received financial support for the following manuscript from the Tim & Linda Tang Anesthesia Research Fund at the University of Calgary. She has previously received a research grant from the Calgary Anesthesia Academic Council. She serves as National Surgical Quality Program Anesthesia Champion at the Foothills Medical Centre in Calgary and as secretary of the Calgary Anesthesia Academic Council.
Each author has indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
