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.