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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2016; 8(5): 353-362
Published online May 27, 2016. doi: 10.4240/wjgs.v8.i5.353
Implications of preoperative hypoalbuminemia in colorectal surgery
Adam Truong, Mark H Hanna, Zhobin Moghadamyeghaneh, Michael J Stamos
Adam Truong, Mark H Hanna, Zhobin Moghadamyeghaneh, Michael J Stamos, Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA 92868, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael J Stamos, MD, Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine Medical Center, 33 City Blvd West Suite 1600, Orange, CA 92868, United States. mstamos@uci.edu
Telephone: +1-714-4566262
Received: October 19, 2015
Peer-review started: October 21, 2015
First decision: December 28, 2015
Revised: January 7, 2016
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 27, 2016
Abstract

Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery.

Keywords: Colorectal surgery, Malnutrition, Albumin, Hypoalbuminemia, Prealbumin, Serum albumin, Nutrition

Core tip: Although albumin remains a flawed marker of nutrition, it offers clear prognostic value in predicting patient outcomes after colorectal surgery. Hypoalbuminemia significantly influences the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. Despite the fact that hypoalbuminemia is classically defined < 3.0 g/dL, clinical judgment must account for albumin levels ≤ 3.4 g/dL as even modest hypoalbuminemia can affect outcomes. The subjective global assessmen, modified Glasgow Prognostic Score, and Colorectal preoperative Surgical Score scoring systems provide convenient and valuable prognostic information that may help in the counseling and risk adjustment of patients undergoing colorectal surgery.