Abstract：
BACKGROUND: Efforts to preoperatively risk stratify and optimize patients before pancreaticoduodenectomy continue to improve outcomes. This study aims to determine the impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy and outline optimal hypoalbuminemia cut-off values in this population.
METHODS: The ACS-NSQIP (2016-2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves.
RESULTS: We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152).
CONCLUSIONS: Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization.
METHODS: The ACS-NSQIP (2016-2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves.
RESULTS: We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152).
CONCLUSIONS: Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization.
摘要：
背景：努力在胰十二指肠切除术前对患者进行术前风险分层和优化以继续改善预后。本研究旨在确定低白蛋白血症对胰十二指肠切除术后预后的影响，并概述该人群的最佳低白蛋白血症临界值。
方法：ACS-NSQIP（2016-2021）数据库用于提取接受胰十二指肠切除术的患者，将低白蛋白血症（<3.0g/L）与白蛋白正常的患者进行比较。比较了人口统计学和30天的结果。多变量模型评估了包括低白蛋白血症在内的因素，以表征其对严重并发症的独立影响，和死亡率。使用受试者工作特征曲线评估了严重并发症和死亡率的最佳白蛋白截止值。
结果：我们评估了25,848例胰十二指肠切除术患者，其中2712例（10.5％）患有术前低蛋白血症。低白蛋白血症患者年龄较大（68.2vs.65.1；p<0.0001)，并且更有可能是ASA4级或更高(13.9%与6.7%；p<0.0001）。低蛋白血症患者的30天并发症明显增多，控制合并症后，低蛋白血症仍然是30天严重并发症的重要独立因素（OR1.80，p<0.0001），但与死亡率无关（OR1.37，p=0.152）。
结论：低白蛋白血症在胰十二指肠切除术后30天发病中起重要作用。术前白蛋白可作为风险分层和优化的有用标志物。
方法：ACS-NSQIP（2016-2021）数据库用于提取接受胰十二指肠切除术的患者，将低白蛋白血症（<3.0g/L）与白蛋白正常的患者进行比较。比较了人口统计学和30天的结果。多变量模型评估了包括低白蛋白血症在内的因素，以表征其对严重并发症的独立影响，和死亡率。使用受试者工作特征曲线评估了严重并发症和死亡率的最佳白蛋白截止值。
结果：我们评估了25,848例胰十二指肠切除术患者，其中2712例（10.5％）患有术前低蛋白血症。低白蛋白血症患者年龄较大（68.2vs.65.1；p<0.0001)，并且更有可能是ASA4级或更高(13.9%与6.7%；p<0.0001）。低蛋白血症患者的30天并发症明显增多，控制合并症后，低蛋白血症仍然是30天严重并发症的重要独立因素（OR1.80，p<0.0001），但与死亡率无关（OR1.37，p=0.152）。
结论：低白蛋白血症在胰十二指肠切除术后30天发病中起重要作用。术前白蛋白可作为风险分层和优化的有用标志物。
