Replacement of albumin after abdominal surgery

Introduction

Replacement of albumin in hypoalbuminemic patients is not proven to reduce postoperative morbidity and mortality but no broad consensus is reached yet on abandoning the use of albumin in intensive care and perioperative settings for the bad prognostic value of hypoalbuminemia. As the albumin decrease in major surgery is mostly due to extravascular leakage of albumin (systemic inflammatory response), we regard hypoalbuminemia just as a marker of inflammatory response to surgery that albumin replacement cannot change. So the postoperative morbidity, mortality and length of stay would not differ in patients without albumin replacement.

Materials and methods

We retrospectively studied 76 successive patients operated on in the abdomen at the Oncologic Institute in Ljubljana in 1997/98 (group 1 – postoperative hypoalbuminemia treated with 20% albumin solution) and in 2000/01 (group 2 – no albumin treatment), because of abandoning albumin use in our surgical department. We compared serum albumin concentrations in the first week after surgery (three values) as well as the postoperative complication rate and the length of hospital stay. We looked for correlation between the postoperative albumin concentration and the duration of surgery, amount of transfusion and amount of infusion during surgery.

Results

The two groups of 38 patients were comparable in age (52.4 and 56.5 years), ASA physical status (1.9 and 2.0), preoperative albumin concentration (39.0 and 38.1 g/l), duration of operation (5.9 and 6.1 hours), transfused red blood cells (3.3 and 2.0 l) and crystalloid infusion during surgery (5.3 and 4.5 l). In both groups there was very significant drop of albumin concentration in the first week after surgery (P < 0.001). In group 2 albumin concentrations were very significantly lower than in group 1 until the fifth postoperative day (P < 0.001). The difference diminished after the sixth postoperative day (P < 0.03). There was negative correlation between the postoperative albumin concentration and the duration of surgery (r = -0.44, P < 0.008). We found no difference in the postoperative complication rate (surgical or medical), length of stay and mortality between the groups.

Conclusion

Postoperative serum albumin concentrations were reduced in both groups, but more in group 2 with no albumin treatment, and in longer operations. Morbidity, mortality and length of stay were not influenced by albumin replacement.