Early postoperative serum albumin decline as a predictor of complications following emergency exploratory laparotomy for duodenal perforation

Ranjeet Kumar Rajak; Anil Kumar Kamal; Kumar Gaurav; Madhu

doi:10.18203/2320-6012.ijrms20263708

Authors

Ranjeet Kumar Rajak Department of General Surgery, R. I. M. S., Ranchi, Jharkhand, India
Anil Kumar Kamal Department of General Surgery, R. I. M. S., Ranchi, Jharkhand, India
Kumar Gaurav Department of General Surgery, R. I. M. S., Ranchi, Jharkhand, India
Madhu Department of Obstetrics and Gynaecology, R. I. M. S., Ranchi, Jharkhand, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263708

Keywords:

Postoperative albumin decline, Duodenal perforation, Emergency laparotomy, Hypoalbuminemia, ΔAlb

Abstract

Background: Emergency laparotomy for duodenal perforation carries substantial postoperative morbidity and mortality. Serum albumin falls after surgery because of inflammation-driven suppression of hepatic synthesis, capillary leak, and catabolism. We examined whether early postoperative changes in serum albumin are associated with complications and mortality after emergency surgery for duodenal perforation.

Methods: This single-centre prospective observational study was conducted over 18 months in the Department of General Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi, India. A total of 125 patients undergoing emergency exploratory laparotomy for duodenal perforation were enrolled. Serum albumin was measured preoperatively and on postoperative days (POD) 2 and 5. The outcomes were surgical site infection (SSI), wound dehiscence, burst abdomen, bile leak, intensive care unit (ICU) requirement, and in-hospital mortality. Albumin was compared across time points and between survivors and non-survivors, and survival was analysed by albumin category (<2.5 versus ≥2.5 g/dl). A p value <0.05 was considered statistically significant.

Results: The mean age was 39.30±12.05 years, and 75 patients (60%) were male. Mean serum albumin was 2.80±1.09 g/dl preoperatively, 2.44±1.09 g/dl on POD 2, and 2.60±1.09 g/dl on POD 5 (repeated-measures ANOVA, p=0.034); the preoperative-to-POD 2 decline of 0.36 g/dl was significant on pairwise comparison (p=0.026). SSI and wound dehiscence each occurred in 66 patients (52.8%), burst abdomen in 38 (30.4%), and bile leak in 12 (9.6%). In-hospital mortality was 9.6% (12/125). Survivors had significantly higher albumin than non-survivors at all three time points (p<0.001). Survival was 100% in patients with albumin ≥2.5 g/dl and 79.3% in those with albumin <2.5 g/dl. In multiple linear regression, only length of hospital stay was an independent predictor of mortality.

Conclusions: Serum albumin fell significantly within 48 hours of emergency laparotomy for duodenal perforation, and low albumin levels, both before and after surgery, were associated with in-hospital mortality. Serial albumin measurement is a simple and inexpensive adjunct for postoperative risk stratification. However, albumin was not an independent predictor of mortality in multivariable analysis, and larger studies are needed to establish the prognostic value of the albumin decline itself.

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