Abstract

Background: Serum albumin has a close correlation with degree of malnutrition which is associated with poor outcome and quality of life after cardiac surgery. Hypoalbuminemia is associated with increased wound infection; prolonged hospital stays and death after major surgery. Hence, preoperative serum albumin level can be utilized to upgrade risk models which will further benefit the cardiac surgical patients without extra financial burden. Objective of this study was to evaluate the role of serum albumin as a predictor of outcome after valve replacement surgery.

Methods: This comparative cross-sectional study was carried out at the department of cardiac surgery in BSMMU. The study population was 50, with two groups having 25 patients each. Grouping of patients were done with respect to a preset cut off value for serum albumin. The period of study was from August, 2018 to February, 2020 and purposive sampling method was applied for this study. Data was collected by using a standardized semi-structured questionnaire and face to face interview.

Results: By demographic characteristics, mean age was significantly higher in group B (49.96 ± 8.69 years) than in group A (41.60 ± 11.16 years) (p=0.005). Mean BMI was lower in group B (20.88 ± 3.71 kg/m2) than in group A (22.26 ± 1.67 kg/m2), which was found statistically significant (p=0.006). In terms of postoperative outcome, total chest drain collection was significantly higher in group B (968.80 ± 183.49 ml) than in group A (816.00 ± 113.40 ml), (p=0.001). Duration of ICU stay were significantly longer in group B (4.60 ± 0.76 days) than in group A (3.92 ± 0.86 days) (p=0.005). Similarly, duration of hospital stay was significantly longer in group B (9.88 ± 1.56 days) than in group A (8.64 ± 0.81 days) (p=0.001). Overall morbidity was significantly higher in group B (48%) than in group A (20%) (p<0.05). Mortality rate was higher in group B (12%) than in group A (4%), but that was not found statistically significant (p>0.05). Pearson co-efficient correlation test showed strong inverse relationship of serum albumin with total chest drain, ICU stay and hospital stay following valve replacement surgery (r=-0.473, r=-0.448 & r=-0.487 respectively), which was most significant than age and BMI (p ≤ 0.001). Multivariate logistic regression analysis was done to assess the predictive value of serum albumin level, age and BMI, where preoperative serum albumin level was found to be the most valuable predictor of postoperative outcome after valve replacement surgery (B=-2.251, OR 0.105, 95% CI 0.011-0.986, p<0.05).

Conclusion: This study demonstrated that preoperative low serum albumin level is associated with increased morbidity and mortality after valve replacement surgery. Hence, preoperative serum albumin level can be used as a reliable predictor of postoperative outcome following valve replacement surgery.

Keywords: Outcome; Morbidity; In-hospital mortality; Preoperative; Serum albumin level; Valve replacement surgery