Laparoscopic Hepatectomy Reduces the Incidence of Postoperative Hypoalbuminemia: A Propensity Score Matching Analysis with Open Hepatectomy

Abstract

Background: This study investigated the incidence of post-hepatectomy hypoalbuminemia and the necessity of Intravenous Albumin (ALB) supplement for hypoalbuminemia after Laparoscopic Hepatectomy (LH). Methods: Nine hundred and eighty patients with Open Hepatectomy (OH) and 198 patients with LH were matched on the propensity score by 2:1. The incidences of postoperative hypoalbuminemia and the usage of ALB injection on different Postoperative Days (POD) were compared. Preventive and risk factors of hypoalbuminemia were screened by logistic regression. Receiver Operator Characteristic (ROC) curve and nomogram were established to predict postoperative hypoalbuminemia. Result: 175 patients of LH and 296 patients of OH were matched. The usage of ALB injection was significantly lower in the LH group than those in the OH group (60.0 vs. 75.3%, P=0.000; 6.71 ± 6.99 vs. 8.62 ± 7.18 g, P=0.005). The incidences of postoperative hypoalbuminemia in the LH group were significantly lower than those in the OH group (62.3 vs. 78.4% (P=0.000) on POD 1, 51.4 vs. 71.6% (P=0.000) on POD 3, 37.1 vs. 51.4% (P=0.003) on POD 5, and 27.4 vs. 39.9% (P=0.006) on POD 7). Preoperative serum ALB level and Serum Alanine Aminotransferase (ALT) level was identified as independent protective and risk factor of hypoalbuminemia after LH, respectively. Preoperative serum ALB level below 42.95 g/L and serum ALT level above 28.50 U/L were identified as the reliable cut-off value to predict postoperative hypoalbuminemia after LH. A nomogram for predicting the probability of hypoalbuminemia after LH was established. Conclusion: LH with a reduced intravenous ALB supplement was still associated with a lower incidence of postoperative hypoalbuminemia.