Impact of albumin levels on clinical outcomes in children underwent abdominal surgery

  • Rismala Dewi Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Freddy Guntur Mangapul Silitonga Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Irawan Mangunatmadja Department of Child Health, Universitas Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
DOI: https://doi.org/10.14238/pi60.3.2020.149-53
Keywords: hypoalbuminemia; clinical outcomes; abdominal surgery; pre- and postoperative

Abstract

Background Patients underwent abdominal surgery and had hypoalbuminemia were at risk of post-operative complications. The prognostic role of albumin levels in children with abdominal surgery remains unclear.

Objective To investigate the impact of albumin levels on clinical outcomes related to the complications in children with abdominal surgery.

Methods This was a retrospective cohort study on children aged 29 days to 18 years, who underwent abdominal surgery, had serum albumin levels measured at pre-operative and within 48 hours post-operatively, and hospitalized in Paediatric Intensive Care Unit of Dr. Cipto Mangunkusumo Hospital, Indonesia. The primary outcomes were post-operative complications (sepsis, surgical site infection, shock), length of stay in PICU, dehiscence, relaparotomy, and postoperative mortality.

Results This study recruited a total of 201 children. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were found in 15.4% and 51.2%, respectively. Pre- and post-operative serum albumin levels of ≤ 3.00 g/dL were associated with higher risk of post-operative sepsis (RR 3.4; 95%CI 1.54 to 7.51) and relaparotomy (RR 3.84; 95%CI 1.28 to 1.49). The median of length of PICU stay was 4 days longer in children with pre-operative serum albumin levels ≤ 3.00 g/dL (P<0.001).

Conclusions Hypoalbuminemia condition in children undergo abdominal surgery is associated with increased risk of post-operative sepsis, longer length of stay in PICU, and risk of relaparotomy.

References

1. Alberti LR, Petroianu A, Zac RI, Andrande Jr. JCCG. The effect of surgical procedures on serum albumin concentration. Chirurgia. 1990;103:39-43. PMID: 18459495.
2. Mahkovic-Hergouth K, Kompan L. Is replacement of albumin in major abdominal surgery useful? J Clin Anesth. 2011;23:42–6. DOI: 10.1016/j.jclinane.2010.06.007.
3. Bold J. Use of albumin. Br J Anaesth. 2010;104:276–84. DOI: 10.1093/bja/aep393.
4. Nielsen OM. Sequential changes in circulating total protein and albumin masses after abdominal vascular surgery. Ann Surg. 1985;202:231-4. DOI: 10.1097/00000658-198508000-00014.
5. Garg T, Chen LY, Kim PH, Zhao PT, Herr HW, Donat SM. Preoperative serum albumin is associated with mortality and complications after radical cystectomy. Br J Urol Int. 2014;113:918-23. DOI: 10.1111/bju.12405.
6. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri S. Preoperative serum albumin level as a predictor of operative mortality and morbidity. Arch Surg. 1999;134:36-42. DOI: 10.1001/archsurg.134.1.36.
7. Goh SL, De Silva RP, Dhital K, Gett RM. Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies. Interact Cardiovasc Thorac Surg. 2015;20: 107-13. DOI: 10.1093/icvts/ivu324.
8. Liu X, Wu X, Zhou C, Hu T, Ke J, Chen Y, et al. Preoperative hypoalbuminemia is associated with an increased risk for intraabdominal septic complications after primary anastomosis for Crohn’s disease. Gastroenterol Report. 2017;5:298-304. DOI:10.1093/gastro/gox002.
9. Bohl DD, Shen MR, Kayupov E, Della Valle CG. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty. 2016;31:15-21. DOI: 10.1186/s12893-016-0186-6.
10. Khan R, Qadar M, Maqsood SU, Kashif MA, Hussain MZ, Afzal M. Tension sutures in closure of midline laparotomy-avoidance of wound dehiscence. Pak Armed Forces Med J. 2017;67:S74-7.
11. Kougias P, Salami AC, Sharath S, Garcia A, Pathak A. Preoperative albumin levels and major postoperative complications after elective abdominal aortic aneurysm repair. J Vascular Surg. 2016;63:170-1s.
12. Sun JK, Sun F, Wang X, Yuan ST, Zheng SY, Mu XW. Risk factors and prognosis of hypoalbuminemia in surgical septic patients. Peer J. 2015;3:1-14. DOI: 10.7717/peerj.1267.
13. Ramneesh G, Sheerin S, Surinder S, Bir S. A prospective study of predictors for post laparotomy abdominal wound dehiscence. J Clin Diagn Res. 2014;8:80-3. DOI: 10.7860/JCDR/2014/7348.3921.
14. Walming C, Angenete E, Block M, Bock D, Gessler B, Haglind E. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia. BMC Surg. 2017;17:19-24. DOI: 10.1186/s12893-017-0207-0.
15. Krishna A, Shivaramegowda S, Kumar A, Manjunath S. Relaparotomy – the surgeons nightmare. Indian J Surg. 2018;80:1-6. DOI: DOI: 10.1007/s12262-018-1823-3.
16. Hennessey DB, Burke JP, Ni Donochu T, Conor S, Winter DC, Kenneth M. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multiinstitutional study. Ann Surg. 2010;252:325-9. DOI: 10.1097/SLA.0b013e3181e9819a.
17. Moghadamyeghaneh Z, Hwang G, Hanna MH, Phelan MJ, Carmichael JC, Mills SD, et al. Even modest hypoalbuminemia affects outcomes of colorectal surgery patients. Am J Surg. 2015;210:276–84. DOI: 10.1016/j.amjsurg.2014.12.038.
18. Lohsiriwat V, Chinswangwatanakul V, Lohsiriwat S, Akaraviputh T, Boonnuch W, Methasade A, et al. Hypoalbuminemia is a predictor of delayed postoperative bowel function and poor surgical outcomes in right-sided colon cancer patients. Asia Pac J Clin Nutr. 2007;16:213–17.
19. Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low albumin levels are associatedwith mortality risk in hospitalized patients. Am J Med. 2017;130: 11-9. DOI: 10.1016/j.amjmed.2017.07.020.
20. Hoffman M. The influence of hemophilia on wound healing. Blood. 2009; 114: 1-21. DOI: 10.1182/blood.V114.22.SCI-21.SCI-21.
Published
2020-06-12
How to Cite
1.
Dewi R, Silitonga F, Mangunatmadja I. Impact of albumin levels on clinical outcomes in children underwent abdominal surgery. PI [Internet]. 12Jun.2020 [cited 27Apr.2024];60(3):149-3. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2377
Issue
Vol 60 No 3 (2020): May 2020
Section
Emergency & Pediatric Intensive Care

Copyright (c) 2020 Rismala Dewi, Freddy Guntur Mangapul Silitonga, Irawan Irawan Mangunatmadja

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Received 2020-01-22
Accepted 2020-06-12
Published 2020-06-12