Preoperative hypoalbuminemia and severe acute malnutrition as prognostic factors for postoperative complications in major abdominal surgery: A single-center retrospective study

Lestarina Veronica Haloho; Nurnaningsih Nurnaningsih; Endy Paryanto

doi:10.14238/pi63.5.2023.389-94

Lestarina Veronica Haloho Universitas Gadjah Mada
Nurnaningsih Nurnaningsih Department of Pediatric Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Central Java
Endy Paryanto Department of Pediatric Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Central Java

DOI: https://doi.org/10.14238/pi63.5.2023.389-94

Keywords: postoperative complications; hypoalbuminemia; nutritional status; preoperative

Abstract

Background Hypoalbuminemia and malnutrition are common factors that can adversely affect wound healing and increase the risk of postoperative infections. Improvements in albumin and preoperative nutritional status are expected to reduce the incidence of complications following postoperative abdominal surgery.

Objective To evaluate the roles of hypoalbuminemia and poor preoperative nutritional status as prognostic factors for postoperative complications in pediatric patients undergoing major abdominal surgery.

Methods This retrospective cohort study included pediatric patients aged 1 month to 18 years who underwent major abdominal surgery and were treated in the pediatric intensive care unit (PICU) of Dr. Sardjito Hospital between January 1, 2017 to December 31, 2021. The primary was the incidence of postoperative complications within 14 days after the surgical procedure.

Results Out of the 201 pediatric patients included in the study, 54.7% were male. We observed an overall complication rate of 21.3% following abdominal surgery, with sepsis as the most frequent, affecting 14.9% of the cases. On average, postoperative complications occurred approximately 10.9 days after surgery. Multivariate analysis identified severe acute malnutrition [hazard ratio (HR) 2.09 (95%CI 1.01 to 4.33); P=0.047], preoperative hypoalbuminemia of >2.5 to 3.0 g/dL [HR 3.64 (95%CI 1.57 to 8.41); P=0.003], preoperative hypoalbuminemia ?2.5 g/dL [HR 3.1 (95%CI 1.11 to 8.64); P=0.03], and age <1 year [HR 2.16 (95%CI 1.09 to 4.11); P=0.026] as significant prognostic factors for post-abdominal surgery complications in children.

Conclusion Preoperative severe acute malnutrition and preoperative hypoalbuminemia of ?3 g/dL are significant prognostic factors for the occurrence of postoperative complications in pediatric patients undergoing abdominal surgery. Infants less than one year of age are at increased risk of such complications.

References

Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clin Dermatol. 2007;25:9–18. DOI: https://doi.org/10.1016/j.clindermatol.2006.09.007.
2. Schricker T, Lattermann R. Perioperative catabolism. Can J Anesth. 2015;62:182–93. DOI: https://doi: 10.1007//s12630-014-0274-y.
3. Norberg Å, Rooyackers O, Segersvärd R, Wernerman J. Albumin kinetics in patients undergoing major abdominal surgery. PLoS One. 2015;10:e0136371. DOI: https://doi.org/ 10.1371/journal.pone.0136371.
4. Meilany TA, Alexandra A, Arianto A, Bausat Q, Endang SK, Prihartono J, et al. Pengaruh malnutrisi dan faktor lainnya terhadap kejadian wound dehiscence pada pembedahan abdominal anak pada periode perioperatif. Sari Pediatr. 2012;14:110–6. DOI: https://doi.org/10.14238/sp14.2.2012.110-6.
5. Bergkvist E, Zimunhu T, Mbanje C, Hagander L, Muguti GI. Nutritional status and outcome of surgery: a prospective observational cohort study of children at a tertiary surgical hospital in Harare, Zimbabwe. J Pediatr Surg. 2021;56:368–73. DOI: https://doi.org/10.1016/j.jpedsurg.2020.09.020.
6. Dewi R, Silitonga FGM, Mangunatmadja I. Impact of albumin levels on clinical outcomes in children underwent abdominal surgery. Paediatr Indones. 2020;60:149–53. DOI: https://doi.org/10.14238/pi60.3.2020.149-53
7. Alamsyah WN, Rochadi. Faktor-faktor yang mempengaruhi komplikasi, lama perawatan, dan mortalitas pada operasi invaginasi berdasarkan status gizi bayi dan anak di RSUP Dr.Sardjito tahun 2007-2012. [thesis]. Yogyakarta: Universitas Gadjah Mada; 2013.
8. Radman M, Mack R, Barnoya J, Castañeda A, Rosales M, Azakie A, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg. 2014;147:442-50. DOI: https:// doi.org/10.1016/j.jctvs.2013.03.023. PMID: 2353172.
9. ?im?ek T, ?im?ek HU, Cantürk NZ. Response to trauma and metabolic changes: posttraumatic metabolism. Ulus Cerrahi Derg. 2014;30:153–9. DOI: https://doi.org/ 10.5152/UCD.2014.2653. PMID: 25931917
10. Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg. 2010;252:325–9. DOI: https://doi.org/10.1097/SLA.0b013e3181e9819a
11. Yanni GN, Lubis M, Ali M. The influence of albumin level in critically ill children to length of stay and mortality in paediatric intensive care unit. Open Access Maced J Med Sci. 2019;7:3455–8. PMID: 32002073.
12. Lohsiriwat V, Lohsiriwat D, Boonnuch W, Chinswangwatanakul V, Akaraviputh T, Lert-Akayamanee N. Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World J Gastroenterol. 2008;14:1248–51. DOI: https://doi: 10.3748/wjg.14.1248. PMID:18300352.
13. Yang SS, Yu CS, Yoon YS, Yoon SN, Lim SB, Kim JC. Risk factors for complications after bowel surgery in Korean patients with Crohn’s disease. J Korean Surg Soc. 2012;83:141–8. DOI: https://doi.org/10.4174/jkss.2012.83.3.141. PMID:22977760
14. Van Ramshorst GH, Salu NE, Bax NMA, Hop WCJ, Van Heurn E, Aronson DC, et al. Risk factors for abdominal wound dehiscence in children: a case-control study. World J Surg. 2009;33:1509–13. DOI: https://doi.org/10.1007/s00268-009-0058-7.
15. Talabi AO, Sowande OA, Adeneken, AT, Adejuyigbe O, Adumah CC, Igwe AO. A 10-year retrospective review of perioperative mortality in pediatric general surgery at Ile-Ife Hospital, Nigeria. J Pediatr Surg [Internet]. 2018;3–7. DOI: https://doi.org/10.1016/j.jpedsurg.2018.03.005.
16. Torborg A, Cronje L, Thomas J, Meyer H, Bhettay A, Diedericks J, et al. South African Paediatric Surgical Outcomes Study: a 14-day prospective, observational cohort study of paediatric surgical patients. Br J Anaesth. 2019;122:224–32. DOI: https://doi.org/10.1016/j.bja.2018.11.015