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Impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy: a NSQIP retrospective cohort analysis of 25,848 patients

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Abstract

Background

Efforts to preoperatively risk stratify and optimize patients before pancreaticoduodenectomy continue to improve outcomes. This study aims to determine the impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy and outline optimal hypoalbuminemia cut-off values in this population.

Methods

The ACS-NSQIP (2016–2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves.

Results

We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152).

Conclusions

Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization.

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Acknowledgements

AMJS serves as a consultant to ViaCyte Inc., Vertex Inc., Betalin Ltd., Hemostemix Inc. and Aspect Biosystems Ltd. Taylor Sawchuk, Kevin Verhoeff, Uzair Jogiat, Valentin Mocanu, Blaire Anderson, Khaled Dajani, and David Bigam have no conflicts of interest to disclose. Taylor Sawchuk, Kevin Verhoeff, Uzair Jogiat, Valentin Mocanu, James Shapiro, Blaire Anderson, Khaled Dajani, and David Bigam did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Taylor Sawchuk

  2. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Kevin Verhoeff, Uzair Jogiat, Valentin Mocanu, A. M. James Shapiro, Blaire Anderson, Khaled Dajani & David L. Bigam

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Contributions

Taylor Sawchuk assisted with methodology, investigation, editing, and original draft writing. Kevin Verhoeff assisted with conceptualization, methodology, data curation and analysis, investigation, editing, and supervision. Uzair Jogiat and Valentin Mocanu assisted with methodology, data analysis, and manuscript editing. A.M. James Shapiro, Blaire Anderson, Khaled Dajani, and David Bigam assisted with conceptualization, methodology, manuscript editing, and supervision.

Corresponding author

Correspondence to Kevin Verhoeff.

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Disclosures

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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This study was exempt from ethics review.

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Sawchuk, T., Verhoeff, K., Jogiat, U. et al. Impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy: a NSQIP retrospective cohort analysis of 25,848 patients. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-11018-z

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