Journal Article

Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?

Pamela L. Karas, Sean L. Goh and Kumud Dhital

in Interactive CardioVascular and Thoracic Surgery

Volume 21, issue 6, pages 777-786
Published in print December 2015 | ISSN: 1569-9293
Published online September 2015 | e-ISSN: 1569-9285 | DOI: https://dx.doi.org/10.1093/icvts/ivv247
Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?

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A best evidence topic was written according to a structured protocol. The clinical question investigated was: is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery? There were 62 papers retrieved using the reported search strategy. Of these, 12 publications embodied the best evidence to answer this clinical question. The authors, journal, date and country of the publication, patient group investigated, study design, relevant outcomes and results of these papers were tabulated. This paper includes a total of 12 589 patients, and of the papers reviewed, 4 were level 3 and 8 level 4. Each of the publications reviewed and compared either all or some of the following postoperative complications: mortality, postoperative bleeding requiring reoperation, prolonged hospital stay and ventilatory support, infection, liver dysfunction, delirium and acute kidney injury (AKI). Of the studies that examined postoperative mortality, all except for three established a significant multivariate association with low preoperative albumin level. Some scepticism is required in accepting other results that were only present in univariate analysis. While three studies examined multiple levels of serum albumin, most dichotomized the serum albumin levels into normal and abnormal groups. This led to differing classifications of hypoalbuminaemia, ranging from less than 2.5 to 4.0 g/dl. The available evidence, however, suggests that low preoperative serum albumin level in patients undergoing cardiac surgery is associated with the following: (i) increased risk of mortality after surgery and (ii) greater incidence of postoperative morbidity. While the evidence supports the use of preoperative albumin in assessing post-cardiac surgery complications, a specific level of albumin considered to be abnormal cannot be concluded from this review.

Keywords: Serum albumin level; Preoperative assessment; Postoperative care; Postoperative complications; Cardiac surgery

Journal Article.  3793 words. 

Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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