Preoperative Hypoalbuminemia is Associated with Increased Mortality in Patients Undergoing Surgery for Gynaecologic Malignancy - A Retrospective Cohort Study.

OBJECTIVE: Our objective was to evaluate the significance of reduced preoperative albumin levels on short-term (90-day and 1-year) mortality in patients undergoing surgery for gynaecologic malignancy in Calgary, Alberta, Canada. METHODS: In this retrospective cohort study, patients with gynaecologic malignancies who had surgery performed at Foothills Medical Centre in Calgary, Alberta, Canada between January 1, 2010, and June 30, 2016, were identified. We performed univariable and multivariable logistic regression analyses to evaluate the association between preoperative serum albumin and 90-day and 1-year mortality. Analysis was conducted with albumin initially as a continuous variable, and subsequently as a categorical variable after clinically relevant threshold levels were identified. RESULTS: A total of 2183 patients were included in our analysis. Of the study population, 51.8% had a preoperative serum albumin level of <35 g/L. Two critical inflection points in mortality rate by serum albumin level were found. Mortality was significantly highest in patients with an albumin level <20 g/L (90-day mortality 17.2%, 1-year mortality 31.9%) and next highest in patients with an albumin level of 20-25 g/L (90-day mortality 2.7%, 1-year mortality 12.0%), compared to patients with a level of >25 g/L (90-day mortality 0.9%, 1-year mortality 3.9%). In both univariable and multivariable analyses, preoperative hypoalbuminemia was significantly and independently associated with increased 90-day and 1-year mortality (P < 0.001). CONCLUSION: Preoperative hypoalbuminemia is independently associated with increased mortality. Patients with gynaecologic malignancies undergoing surgery and who have a preoperative serum albumin level of <20 g/L are at a very high risk of short-term mortality.

Implementation of a Perioperative Glycemic Management Quality Improvement Pathway in Gynecologic Oncology Patients: A Single-cohort Interrupted Time-series Analysis.

OBJECTIVE: We evaluated implementation and clinical outcomes of a perioperative glycemic management pathway in gynecologic oncology. METHODS: Interrupted time-series analysis was used to compare process, balancing and outcome measures and clinical outcomes from 18 months preimplementation to 18 months postimplementation. RESULTS: Compared with in the preimplementation period, the proportion of patients who underwent preoperative screening with glycated hemoglobin in the postimplementation period increased by 11.3% (95% confidence interval [CI], 5.0% to 17.7%; p=0.001). The proportion of patients with diabetes who had at least 1 blood glucose measurement after surgery increased by 15.3% (95% CI, -3.2% to 33.8%; p=0.10). There was no change in the proportion of patients who had any hyperglycemia or moderate or severe hyperglycemia. The median length of stay decreased by 0.42 days (95% CI, -0.91 to 0.07 days; p=0.09). There were major quality gaps in perioperative glycemic management that did not clearly improve after implementation of a multidisciplinary care pathway. CONCLUSION: Optimal strategies for improvement of perioperative glycemic management are not yet known.