• Clin Nutr · Oct 2017

    Preoperative hypoalbuminemia is associated with worse outcomes in colon cancer patients.

    • Ivy N Haskins, Mary Baginsky, Richard L Amdur, and Samir Agarwal.
    • Department of Surgery, Division of Colon and Rectal Surgery, The George Washington University, Washington, DC, USA. Electronic address: ihaskins@gwu.edu.
    • Clin Nutr. 2017 Oct 1; 36 (5): 1333-1338.

    Background & AimsThe National Veterans' Affairs Surgical Risk Study identified preoperative hypoalbuminemia as an independent risk factor for postoperative morbidity and mortality. Since that time, few studies have investigated the use of preoperative markers as tools to risk stratify colon cancer patients. The purpose of our study is to determine if there is an association between preoperative hypoalbuminemia and 30-day patient morbidity and mortality in colon cancer patients using the Targeted-Colectomy American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP).MethodsStage I, II, and III elective colon resections with ileocolostomy or colocolostomy were identified within the ACS-NSQIP targeted colectomy database from 2012 through 2013. Hypoalbuminemia was defined as albumin <3.5 g/dL. Patients with hypoalbuminemia were compared to those with a normal albumin level in terms of 30-day morbidity and mortality. The albumin level at which point 30-day morbidity and mortality increased was identified.ResultsA total of 5143 patients met inclusion criteria; 4397 (85.5%) patients had a normal albumin level while 746 (14.5%) had hypoalbuminemia. Preoperative hypoalbuminemia significantly increased the risk of 30-day mortality (p < 0.0001). The association of hypoalbuminemia with 30-day outcomes was more significant in patients who underwent open surgery and had an intra-abdominal anastomosis. The risk of an adverse event was observed to increase at an albumin level ≤3.1 g/dL.ConclusionsPreoperative hypoalbuminemia is associated with an increased risk of early patient morbidity and mortality in patients undergoing surgery for colon cancer. Preoperative optimization of this patient population warrants further investigation in order to prevent delay from surgical intervention to adjuvant therapy.Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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