Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1434-1441
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1434
Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer
Dan Xie, Ping-Lan Lu, Wen Xu, Jing-Ya You, Xiao-Gang Bi, Ying Xian
Dan Xie, Wen Xu, Jing-Ya You, Xiao-Gang Bi, Ying Xian, Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, Guangdong Province, China
Ping-Lan Lu, Department of Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
Author contributions: Xie D and Lu PL contributed equally to this work; Xie D and Lu PL design the experiment; Xie D, Lu PL and Xian Y drafted the work; Xie D, Lu PL and Xian Y collected the data; Xu Wen and You JY analysed and interpreted data; Bi XG and Xian Y revised and proofed the manuscript.
Institutional review board statement: The study was reviewed and approved by the medical ethics committee of the Third Affiliated Hospital of Sun Yat-sen University, China (No. II2023-131-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: All data and materials are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying Xian, MS, Doctor, Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, No. 2693 Kaichuang Avenue, Huangpu District, Guangzhou 510530, Guangdong Province, China. xiany2@mail.sysu.edu.cn
Received: April 19, 2023
Peer-review started: April 19, 2023
First decision: April 28, 2023
Revised: May 18, 2023
Accepted: June 2, 2023
Article in press: June 2, 2023
Published online: July 27, 2023
Processing time: 93 Days and 6.1 Hours
Abstract
BACKGROUND

Perforated peptic ulcer (PPU) is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide. While advances in surgical techniques have improved outcomes for patients with PPU, many factors still affect postoperative hospital stay and overall prognosis. One potential factor is the serum albumin (SA) level, a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.

AIM

To clarify the correlation of SA level on postoperative day 2 with hospital length of stay (HLOS) in patients undergoing emergency surgery for perforated peptic ulcer (PPU).

METHODS

We retrospectively collected and analyzed clinical baseline data, including blood routine and SA levels, of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021. Patients were grouped according to HLOS with 7 d as the cut-off value, and relevant indicators were analyzed using SPSS 26.0.

RESULTS

Of the 37 patients undergoing emergency surgery for PPU referred to our department, 33 had gastric and 4 had duodenal ulcer perforation. The median HLOS was 10 d. There were 8 patients in the ≤ 7-d group (median HLOS: 7 d) and 29 patients in the > 7-d group (median HLOS: 10 d). The ≤ 7-d group had markedly higher SA on postoperative day 2 than the > 7-d group (37.7 g/L vs 32.6g/L; P < 0.05). The SA level on postoperative day 2 was a protective factor for patients with HLOS > 7 d (Odds ratio = 0.629, P = 0.015). The cut-off of SA on postoperative day 2 was 30.6g/L, with an area under the curve of 0.86 and a negative predictive value of 100% for the prediction of HLOS ≤ 7 d.

CONCLUSION

The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU. The pre- and post-operative albumin levels should be monitored, and infusion of human SA should be considered in a timely manner.

Keywords: Perforated peptic ulcer; Emergency surgery; Serum albumin; Hospital length of stay

Core Tip: Serum albumin (SA) level is a useful marker of nutritional status and has been associated with postoperative outcomes in various surgical procedures. This study found that lower SA levels on postoperative day 2 were significantly associated with longer hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer. Monitoring and optimizing SA levels may be an important aspect of perioperative care for this high-risk patient population.