Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2020; 26(11): 1185-1196
Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1185
Preoperative albumin levels predict prolonged postoperative ileus in gastrointestinal surgery
Wen-Quan Liang, Ke-Cheng Zhang, Hua Li, Jian-Xin Cui, Hong-Qing Xi, Ji-Yang Li, Ai-Zhen Cai, Yu-Hua Liu, Wang Zhang, Lan Zhang, Bo Wei, Lin Chen
Wen-Quan Liang, Ke-Cheng Zhang, Jian-Xin Cui, Hong-Qing Xi, Ji-Yang Li, Ai-Zhen Cai, Wang Zhang, Lan Zhang, Bo Wei, Lin Chen, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Hua Li, Department of Surgical Oncology, Xing Tai People's Hospital, Xingtai 054001, Hebei Province China
Yu-Hua Liu, Institute of Army Hospital Management, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Chen L, Wei B, Liang WQ, Zhang KC and Cui JX designed the study; Liang WQ, Zhang KC and Li H wrote the manuscript; Xi HQ and Cai AZ contributed to the patient material; Liu YH and Zhang L collected the clinical data; Zhang W and Li JY contributed to data analysis and validation. Liang WQ, Zhang KC, Li H and Liu YH contributed equally to this work.
Supported by the National Nature Science Foundation of China, No. 81672319 and No. 81972790; and Beijing Nova Program, No. Z181100006218011.
Institutional review board statement: The study was approved by the Research Ethics Committee of the Chinese People’s Liberation Army General Hospital.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The manuscript meets the requirements of the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Lin Chen, MA, MD, PhD, Chief Doctor, Professor, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China. chenlin@301hospital.com.cn
Received: December 20, 2019
Peer-review started: December 20, 2020
First decision: February 18, 2020
Revised: February 20, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 21, 2020
Processing time: 91 Days and 8.2 Hours
Abstract
BACKGROUND

Prolonged postoperative ileus (PPOI) is a prolonged state of “pathological” gastrointestinal (GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutritional status on the development of PPOI in patients who underwent GI surgery. The association between preoperative albumin and PPOI has not been fully studied. We hypothesized that preoperative albumin may be an independent indicator of PPOI.

AIM

To analyze the role of preoperative albumin in predicting PPOI and to establish a nomogram for clinical risk evaluation.

METHODS

Patients were drawn from a prospective hospital registry database of GI surgery. A total of 311 patients diagnosed with gastric or colorectal cancer between June 2016 and March 2017 were included. Potential predictors of PPOI were analyzed by univariate and multivariable logistic regression analyses, and a nomogram for quantifying the presence of PPOI was developed and internally validated.

RESULTS

The overall PPOI rate was 21.54%. Advanced tumor stage and postoperative opioid analgesic administration were associated with PPOI. Preoperative albumin was an independent predictor of PPOI, and an optimal cutoff value of 39.15 was statistically calculated. After adjusting multiple variables, per unit or per SD increase in albumin resulted in a significant decrease in the incidence of PPOI of 8% (OR = 0.92, 95%CI: 0.85-1.00, P = 0.046) or 27% (OR = 0.73, 95%CI: 0.54-0.99, P = 0.046), respectively. Patients with a high level of preoperative albumin (≥ 39.15) tended to experience PPOI compared to those with low levels (< 39.15) (OR = 0.43, 95%CI: 0.24-0.78, P = 0.006). A nomogram for predicting PPOI was developed [area under the curve (AUC) = 0.741] and internally validated by bootstrap resampling (AUC = 0.725, 95%CI: 0.663-0.799).

CONCLUSION

Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. The nomogram provided a model to screen for early indications in the clinical setting.

Keywords: Albumin; Prolonged postoperative ileus; Gastrointestinal surgery; Nomogram; Complications

Core tip: Prolonged postoperative ileus (PPOI) is a common postoperative complication in patients who undergo gastrointestinal surgery. There are relatively few studies examining the influence of a patient’s preoperative nutritional status on the development of PPOI. This study found and further confirmed that preoperative albumin was an independent predictor of PPOI. We further established a nomogram to accurately quantitate the probability of PPOI occurrence. This nomogram can be used to screen for early indications in the clinical setting.