Preoperative Hypoalbuminemia and Surgical Complications in Benign Minimally Invasive Hysterectomy

Study Objective

To evaluate the association between preoperative hypoalbuminemia (<3.5 g/dL) and postoperative complications in patients undergoing minimally invasive hysterectomy for benign conditions.

Design

A prospective cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2020.

Setting

Multi-institutional data collected through the NSQIP database across various U.S. hospitals.

Patients or Participants

A total of 69,325 patients met the inclusion criteria, with 65,920 (95.1%) in the normal preoperative albumin level group (≥3.5 g/dL) and 3,405 (4.9%) exhibiting preoperative hypoalbuminemia.

Interventions

No experimental intervention. Data analysis focused on comparing 30 days postoperative outcomes between albumin level groups.

Measurements and Primary Results

Information collected included demographics data, preoperative data, operative indication and postoperative complications. The primary outcome was the incidence of any postoperative complication, further classified as major or minor using the Clavien-Dindo classification. Patients with hypoalbuminemia had significantly higher complication rates overall (10.5% vs. 6.9%, p<0.001), including minor (8.0% vs. 4.7%, p<0.001) and major (3.4% vs. 2.8%, p=0.022) complications. Hypoalbuminemia was significantly associated with increased risks of reintubation, blood transfusion, surgical site infection, and pneumonia. Multivariable logistic regression confirmed hypoalbuminemia as an independent risk factor for any complications (aOR 1.39, 95% CI 1.23–1.56) and minor complications (aOR 1.52, 95% CI 1.32–1.72). When stratifying into five groups of albumin level, higher preoperative albumin levels were associated with a progressive reduction in complication risks.

Conclusion

Preoperative hypoalbuminemia is an independent predictor of postoperative complications in minimally invasive hysterectomy for benign conditions. Routine preoperative nutritional assessment and optimization, including correction of hypoalbuminemia, should be considered to reduce perioperative morbidity. Further research is needed to assess the effectiveness of such interventions in the perioperative setting and the long-term complications.