Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1434
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
Perforated peptic ulcer (PPU) is a medical emergency that requires immediate surgical intervention. Despite significant advances in surgical techniques, postoperative complications and prolonged hospitalization can still occur and impact patient morbidity and healthcare costs. Serum albumin (SA) level, a widely used marker of nutritional status, has shown to be a reliable predictor of postoperative outcomes in various surgical procedures. However, little is known about its relationship with hospital length of stay (HLOS) in PPU patients undergoing emergency surgery.
PPU is a common and potentially life-threatening medical emergency that requires prompt surgical intervention. While significant advances have been made in surgical techniques, postoperative complications and prolonged hospitalization remain a challenge. Malnutrition and hypoalbuminemia are common in PPU patients and have been associated with unfavorable postoperative outcomes. SA level, a widely used marker of nutritional status, has shown to be a valuable predictor of postoperative outcomes in various surgical procedures. However, its relationship with HLOS in PPU patients undergoing emergency surgery is not well understood. Therefore, this study aims to fill this gap and potentially provide insights into optimizing perioperative care for PPU patients, improving outcomes, and reducing healthcare costs.
The objective of this study is to investigate the correlation between SA levels on postoperative day 2 and HLOS in patients undergoing emergency surgery for PPU. Specifically, the study aims to determine whether lower SA levels on postoperative day 2 are associated with longer HLOS in PPU patients. The findings of this study will provide valuable insights into optimizing perioperative care for PPU patients, potentially reducing the burden of prolonged hospitalization and improving patient outcomes in this high-risk patient population.
In this study, we conducted a retrospective analysis of clinical baseline data, blood routine tests, and SA levels of patients who underwent emergency surgery for PPU at the Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021. Patients were categorized based on their HLOS into two groups: Those with HLOS of ≤ 7 d and those with HLOS of > 7 d. Relevant indices were analyzed using SPSS 26.0 software.
On postoperative day 2, the ≤ 7-d group had significantly higher SA levels than the > 7-d group (37.7 g/L vs 32.6 g/L, P < 0.05). We found that the SA level on postoperative day 2 was a protective factor for patients with an HLOS > 7 d (OR = 0.629, P = 0.015). The cut-off value for SA on postoperative day 2 was 30.6 g/L, with an AUC of 0.86 and a negative predictive value of 100% for predicting an HLOS of ≤ 7 d.
Our study, which investigated the correlation between SA levels on postoperative day 2 and HLOS in patients undergoing emergency surgery for PPU, found that lower SA levels on postoperative day 2 were associated with longer HLOS in PPU patients. We also found that SA level on postoperative day 2 was a protective factor for patients with an HLOS greater than 7 d. Furthermore, we established a cut-off value for SA level on postoperative day 2 that effectively predicts an HLOS of ≤ 7 d. Our findings highlight the potential benefits of monitoring SA levels during the perioperative period of PPU patients, which may improve patient outcomes, reduce healthcare costs, and optimize perioperative care strategies for this high-risk population.
The correlation between SA levels and HLOS in patients undergoing emergency surgery for PPU remains an important area of research. Future studies could focus on examining the association between SA levels and postoperative complications, such as infection, sepsis, and mortality. Additionally, further research could investigate the underlying mechanisms through which SA levels influence HLOS in these patients. This could include exploring the role of albumin in modulating inflammation, oxidative stress, and wound healing. A better understanding of these mechanisms may provide new therapeutic targets for improving outcomes in PPU patients. Finally, future studies could examine the feasibility and effectiveness of interventions aimed at optimizing SA levels in this patient population, including nutritional support, perioperative albumin infusion, and other interventions. Overall, continued research in this area has the potential to improve patient outcomes and identify new approaches to perioperative care in PPU patients.