Preoperative Albumin Is Predictive of Early Postoperative Morbidity and Mortality in Common Urologic Oncologic Surgeries

Using the American College of Surgeons National Surgical Quality Improvement Program database, we explored the relationship between preoperative albumin status and postoperative outcomes in cystectomies, nephrectomies, partial nephrectomies, prostatectomies, and transurethral resection of bladder tumors. Hypoalbuminemia correlated with increased morbidity and mortality, not only in large cases such as cystectomies, but in smaller cases such as transurethral resection of bladder tumors. These findings will assist with preoperative planning and counseling. Introduction Multiple studies have linked preoperative nutrition status to postoperative outcomes. This relationship has been little studied in urology. We used a standardized, national, risk-adjusted surgical database to evaluate 30-day outcomes of patients undergoing common urologic oncologic procedures as they related to preoperative albumin. Methods The American College of Surgeons National Surgical Quality Improvement Program is a risk-adjusted dataset analyzing preoperative risk factors, demographics, and 30-day outcomes. From 2005 through 2012, we identified a total of 17,805 patients who underwent prostatectomy, nephrectomy, partial nephrectomy, cystectomy, or transurethral resection of bladder tumor (TURBT). Hypoalbuminemic patients were compared with those with normal preoperative albumin, and 30-day outcomes were evaluated. Logistic regression analyses were used to estimate odds ratios for mortality and complication rates. Results Evaluation of the cohort noted significantly increased overall morbidity, serious morbidity, and mortality in the hypoalbuminemic group (P < .01 for all procedures). Hypoalbuminemia was associated with a significantly higher 30-day mortality in major procedures such as cystectomy, and in smaller procedures such as TURBT (P < .01). Hypoalbuminemia was associated with a 6.4% 30-day mortality in the TURBT group compared with 0.6% in those with normal albumin (P < .0001). These findings remained significant after adjustment for other risk factors. Conclusions The large sample size, standardized data definitions, and quality control measures of the American College of Surgeons National Surgical Quality Improvement Program database allow for in-depth analysis of subtle but significant differences in outcomes between groups. Serum albumin is a strong predictor of short-term postoperative complications in the urologic oncology patient.