To find the role of postoperative fall in serum albumin as a predictor of outcome after major abdominal surgery
Author(s): Major (Dr. ) Nimesh Kumar Tiwari and Dr. Tanu Priya
Abstract: Introduction: Surgical interventions lead to well-understood metabolic, neuroendocrine, and immune responses, and the stress responses to surgery contribute to increased postoperative complications. Pro-inflammatory cytokines increased due to surgical injury, leads to changes of circulating acute phase proteins, such as albumin and C-reactive protein. Aims and Objectives: To find the role of postoperative fall in serum albumin as a predictor of outcome after major abdominal surgery, perioperative levels of albumin, maximal fall in albumin in early postoperative period, postoperative albumin levels with type of approach and magnitude of surgery in terms of duration of surgery and estimated blood loss, grade of complications and length of hospital stay. Material and Methods: The prospective cohort study was conducted from June 2018 – December 2019 in the Department of Surgery of a tertiary care hospital of the Armed Forces in which 150 patients who underwent routine elective major surgeries. Results: Mean age of the patients was 52.33 ± 12.08 years. 68.67% of the patients were males and 31.33% were females. Maximum fall in serum albumin was observed on first post-operative day, which was higher in the patients who underwent open surgery (69.70%) than laparoscopic surgery (40.47%). Serum albumin levels were significantly lower on POD 1 in comparison to preoperative levels (p<0.0001). Maximum fall in serum hematocrit was observed on third post-operative day, which was higher in the patients who underwent open surgery (71.22%) than laparoscopic surgery (42.86%) (p<0.001). Complications were observed in 49.33% patients; and no deaths occurred. Mean duration of surgery was significantly higher in laparoscopic surgery as compared to open surgery (6.86 ± 0.76 vs 4.14 ± 1.42 hours, p<0.0001). Mean estimated blood loss (ml) was significantly lower in laparoscopic surgery than open surgery (255.68 ± 85.58 vs 472.58 ± 183.92, p<.0001). Mean value of maximum percentage of fall in serum hematocrit level was significantly lower in patients without complications as compared to those with complications (8.88 ± 6.27 vs 12.96 ± 5.3, p<.0001). Mean value of maximum percentage of fall in serum albumin was significantly lower in patients without complications than those with complications (11.41 ± 5.2 vs 20.83 ± 7.23, p<.0001). Conclusion:It is concluded that maximum fall of serum albumin happens on first postoperative day and found to be significantly correlated with complications and important early predictor regarding patient outcome.