Predicting morbidity and mortality in laparoscopic cholecystectomy: Preoperative serum albumin still matters.

ABSTRACT

BACKGROUND: This study examined the association of preoperative serum albumin with outcomes for laparoscopic cholecystectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was retrospectively analyzed from 2005 to 2016 for adult patients undergoing laparoscopic cholecystectomy. Patients were stratified into four groups <3.0 g/dL (Severe Malnutrition), 3.0-<3.5 (Moderate Malnutrition), 3.5-<4.0 (Mild Malnutrition), and ≥4.0 g/dL (Normal Nutrition). The primary outcome of 30-day mortality was evaluated with multivariable regression. RESULTS: Of 131,855 patients, 14.0% had Severe, 22.8% Moderate, and 29.7% Mild Malnutrition, with 33.5% classified as Normal Nutrition. Adjusted multivariable regressions demonstrated that relative to Normal Nutrition, mortality risk was increased for Severe (OR = 3.09 [95% Confidence Interval 2.09-4.56]) and Moderate (OR = 1.83 [1.24-2.72]) Malnutrition. Severe (OR = 2.45 [1.67-3.61]) and Moderate (OR = 1.52 [1.04-2.24]) Malnutrition were also associated with increased risk of postoperative septic shock. CONCLUSIONS: Even in less invasive laparoscopic cholecystectomy, reduced preoperative serum albumin is strongly associated with increased morbidity and mortality.