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

Main Article Content

Rismala Dewi
Freddy Guntur Mangapul Silitonga
Irawan Mangunatmadja

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.

Article Details

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 11Jul.2020];60(3). Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2377
Section
Emergency & Pediatric Intensive Care
Received 2020-01-22
Accepted 2020-06-12
Published 2020-06-12

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.