BackgroundAlbumin is an important protein that transports hormones, fatty acids, and exogenous drugs; it alsomaintains plasma oncotic pressure. Albumin is considered a negative active phase protein because itdecreases during injuries and sepsis. In spite of other factors predicting surgical outcomes, the effectof pre and postoperative serum albumin to surgical complications could be assessed by calculatingpercentage decrease in albumin (Delta albumin). This study aimed to explore perioperative serumalbumin as a predictor of adverse outcomes in major abdominal surgeries.

Methodology:All adults’ eligible participants from Kilimanjaro Christian Medical Centre Surgical Department wereenrolled conveniently. Data were collected using study questionnaire. Full Blood Count (FBP), serumalbumin levels preoperatively and on postoperative day 1 was measured abiding to LaboratoryStandard Operating Procedures (SOP). Data was entered and analyzed using STATA version 14.Association and extent of decrease in albumin levels as a predictor of surgical site infection (SSI),delayed wound healing and death within 30days of surgery was determined using ordinal logisticregression model. In determining the diagnostic accuracy, a Non-parametric Receiver OperatingCurve (ROC) model was used. We adjusted for ASA classification which had negative confoundingeffect on the predictive power of percent drop in albumin to adverse outcomes.

Results61 participants were studied; the mean age was 51.6 (SD16.3), majorities were males 40 (65.6%) andpost-operative adverse outcome happened to 28 (45.9%) participants. In preoperative serum albuminvalues, 40 (67.8%) had lower than 3.4 g/l while 51 (91%) had postoperative albumin values lowerthan 3.4 g/l. Only 15 (27.3%) had high delta albumin with the median percentage value of 14.77%.Delta albumin was an independent significant factor associated with adverse outcome (OR: 6.68; 95%CI: 1.59, 28.09); with a good predictive power and area under ROC curve (AUC) of 0.72 (95% CI 0.550.89). The best cutoff value was 11.61% with the sensitivity of 76.92% and specificity of 51.72%.

ConclusionEarly perioperative decrease in serum albumin level may be a good, simple and cost effective tool topredict adverse outcomes in major abdominal surgeries.