Preoperative Albumin Is Predictive of Early Postoperative Morbidity and Mortality in Common Urologic Oncologic Surgeries.

Autor: Caras RJ; Urology Department, Tripler Army Medical Center, Honolulu, HI. Electronic address: RJCaras@gmail.com., Lustik MB; Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI., Kern SQ; Urology Department, Tripler Army Medical Center, Honolulu, HI., McMann LP; Urology Department, Tripler Army Medical Center, Honolulu, HI., Sterbis JR; Urology Department, Tripler Army Medical Center, Honolulu, HI.
Jazyk: angličtina
Zdroj: Clinical genitourinary cancer [Clin Genitourin Cancer] 2017 Apr; Vol. 15 (2), pp. e255-e262. Date of Electronic Publication: 2016 Sep 23.
DOI: 10.1016/j.clgc.2016.09.008
Abstrakt: Introduction: Multiple studies have linked preoperative nutrition status to postoperative outcomes. This relationship has been little studied in urology. We used a standardized, national, risk-adjusted surgical database to evaluate 30-day outcomes of patients undergoing common urologic oncologic procedures as they related to preoperative albumin.
Methods: The American College of Surgeons National Surgical Quality Improvement Program is a risk-adjusted dataset analyzing preoperative risk factors, demographics, and 30-day outcomes. From 2005 through 2012, we identified a total of 17,805 patients who underwent prostatectomy, nephrectomy, partial nephrectomy, cystectomy, or transurethral resection of bladder tumor (TURBT). Hypoalbuminemic patients were compared with those with normal preoperative albumin, and 30-day outcomes were evaluated. Logistic regression analyses were used to estimate odds ratios for mortality and complication rates.
Results: Evaluation of the cohort noted significantly increased overall morbidity, serious morbidity, and mortality in the hypoalbuminemic group (P < .01 for all procedures). Hypoalbuminemia was associated with a significantly higher 30-day mortality in major procedures such as cystectomy, and in smaller procedures such as TURBT (P < .01). Hypoalbuminemia was associated with a 6.4% 30-day mortality in the TURBT group compared with 0.6% in those with normal albumin (P < .0001). These findings remained significant after adjustment for other risk factors.
Conclusions: The large sample size, standardized data definitions, and quality control measures of the American College of Surgeons National Surgical Quality Improvement Program database allow for in-depth analysis of subtle but significant differences in outcomes between groups. Serum albumin is a strong predictor of short-term postoperative complications in the urologic oncology patient.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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