Skip to main content
NCBI home page
BMC Anesthesiology logoLink to BMC Anesthesiology
. 2026 Jan 30;26:142. doi: 10.1186/s12871-025-03329-y

Hypoalbuminaemia contributes to postoperative pulmonary complications and mortality: a systematic review and meta-analysis

Xi Wang 1, Hong Tang 1, Mingke Zheng 1, Fang Xu 1,✉
PMCID: PMC12930608  PMID: 41618142

Abstract

Objective

This review aimed to assess whether hypoalbuminaemia can predict postoperative pulmonary complications (PPCs) and mortality in patients receiving general anaesthesia for surgery.

Methods

PubMed, Web of Science, EMBASE, and the Cochrane Library were searched for relevant articles published up to 18 July 2024. Three authors independently reviewed the studies and assessed the quality of related articles via the Newcastle‒Ottawa Scale. The data were recorded, and a meta-analysis was performed using Review Manager version 5.4.1.

Results

A total of 40 studies with 477,701 patients were included in the meta-analysis. Adjusted data were pooled to calculate the odds ratio (OR). A sensitivity test was conducted. A meta-analysis of 18 studies demonstrated that hypoalbuminaemia was a significant predictor of PPCs and mortality after general anaesthesia (OR: 2.88, 95% CI 2.50 to 3.32, P < 0.01, I2 = 90%). The 40 studies were divided into 4 groups based on surgical site: the orthopaedic surgery group (OR: 4.03, 95% CI 3.49 to 4.64, P < 0.01, I2 = 43%), the thoracic surgery group (OR: 1.82, 95% CI 1.46 to 2.26, P < 0.01, I2 = 23%), the abdominal surgery group (OR: 2.48, 95% CI 1.81 to 3.40, P < 0.01, I2 = 95%) and the other surgery group (OR: 2.34, 95% CI 1.66 to 3.29, P < 0.01, I2 = 87%). In addition, patients with hypoalbuminaemia had increased mortality (OR: 4.31, 95% CI 4.124.51, P, I2 = 68%).

Conclusions

Preoperative hypoalbuminaemia is significantly associated with postoperative pulmonary complications and has different correlation coefficients in different types of surgeries.

Trial registration

This systematic review and meta-analysis was registered at the International Prospective Register of Systematic Reviews (Number CRD42024540493).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-025-03329-y.

Keywords: Postoperative pulmonary complications, PPC, Hypoalbuminaemia, Postoperative complications, Malnutrition, Systematic review

Introduction

Although perioperative care for patients undergoing major surgery has progressed, postoperative pulmonary complications (PPCs) are still a leading cause of morbidity and mortality. PPCs include postoperative pneumonia, respiratory failure, pleural effusion, atelectasis, pneumothorax, and delayed mechanical ventilation, typically within the first week after surgery [1]. PPCs are also predictors of short-term and long-term health outcomes after surgery and are associated with an increased risk of admission to critical care and a prolonged length of hospital stay. Between 14% and 30% of patients who develop a PPC die within 30 days of major surgery, whereas only 0.2–3% of those without a PPC die within 30 days [2]. The causes of PPCs are multifactorial and relate to both the patient’s chronic health and the acute adverse effects of surgery with accompanying anaesthesia. If we can monitor the risk factors for PPCs more comprehensively, multiple opportunities could be managed to intervene and therefore potentially prevent the development of PPCs.

Currently, there are no systematic guidelines or consensus on the prevention and risk factors for PPCs in patients undergoing surgery under general anaesthesia. Singh P [3] provided a consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy, but the consensus did not mention the influence of hypoalbuminaemia. A recent meta-analysis on risk factors for PPCs revealed that PPCs are associated with TNM stage, smoking, COPD, diabetes, etc., without any mention of hypoproteinaemia [2].

In respiratory pathophysiology, hypoalbuminaemia profoundly influences the pathogenesis, severity, treatment response, and prognosis of respiratory diseases through multiple mechanisms, including reduced oncotic pressure, impaired anti-inflammatory and antioxidant capacity, altered drug metabolism, and promotion of a hypercoagulable state. However, the correlation coefficient of hypoalbuminaemia varies across different scoring systems, and currently, there are no studies on the impact of hypoalbuminaemia on postoperative complications for different types of surgeries. To the best of our knowledge, no review has attempted to collate the published evidence. Hence, the current study was designed to pool data from published studies to assess whether hypoalbuminaemia can predict the morbidity of PPCs in patients undergoing general anaesthesia during surgery.

Methods

Protocol and registration

This systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (CRD42024540493). This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

The population (P) included randomized controlled trials (RCTs) and retrospective case‒control studies of adults (aged ≥ 18 years) who underwent general anaesthesia during surgery; the intervention (I) was patients with hypoalbuminaemia (defined as albumin levels < 3.5 g/dL, including levels < 3.0 g/dL); and the comparison (C) was patients who underwent general surgery with normal levels of albumin (defined as albumin levels ≥ 3.5 g/dL). The outcomes (O) were postoperative pulmonary complications, including postoperative pneumonia, postoperative respiratory failure, postoperative ARDS, postoperative pneumothorax, pleural effusion and atelectasis. The study design (S) included comparative studies, generally in the form of cohorts or case‒control studies. The exclusion criteria were studies with a high risk of bias; significant clinical heterogeneity; duplicated, missing, or incomplete data; or those that did not report the variables of interest. By adhering to these criteria, this meta-analysis aimed to reduce the risk of bias and increase the reliability and validity of the results.

Search strategy

Systematic searches were performed on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to June 2024. The search was restricted to articles published in English and full-text versions. Our search strategy was based on two search themes: (1) “hypoalbuminaemia” or “serum albumin” or (2) “pulmonary complications” or “pneumonia” or “respiratory complications” (Supplementary file). A manual search was also conducted to identify additional relevant studies.

Data extraction and statistical analyses

Data extraction was independently completed by two researchers (Xi Wang and Mingke, Zheng), and any discrepancy was resolved by consensus. The following variables were collected from the included papers: Author’s first name, year of publication, study design, country of origin, sample size, characteristics of participants, and risk factors. The definition of each variable was confirmed according to the corresponding criteria in the included studies.

Quality of the included studies

Two reviewers (Xi Wang and Hong Tang) independently assessed the quality of the included studies via the Newcastle‒Ottawa Scale (NOS), which consists of selection (0–4 points), comparability (0–2 points), and outcome (for RCTs) or exposure (for case-control studies) (0–3 points), and any disagreements were resolved by discussion with the third author (Mingke Zheng). A NOS score ≥ 6 represented a relatively high-quality study.

Statistical analyses

We estimated the pooled relative risk ratio (RR) or odds ratio (OR) and corresponding 95% confidence interval (CI) for binary variables via the Mantel‒Haenszel (M-H) method and the pooled weight mean difference (WMD) and corresponding 95% CI for continuous variables via the inverse variance (IV) method. Heterogeneity was tested by both the Cochran chi-square test (Q test) and the I2 test, and P < 0.1 or I2 ≥ 75% indicated marked heterogeneity among studies. If there was marked heterogeneity (I2 ≥ 50%), a random effects model was used to pool the data; otherwise, a fixed effects model was used. If necessary, sensitivity analysis was conducted by excluding outlier studies one by one to determine the source of heterogeneity. If more than 10 articles were included in a comparison, potential publication bias was detected via a funnel plot. All analysis procedures were conducted with Review Manager 5.4.1 software.

Results

Characteristics of the included studies

The flow diagram of the study screening process is shown in Fig. 1. A total of 8745 articles were initially identified from the electronic database. After duplicates were removed (n = 4809), 3936 abstracts were screened. After screening the titles and abstracts, 3412 articles were excluded. After the full texts of the remaining 524 studies were reviewed, 484 articles were excluded, and 40 studies with 477,701 patients were ultimately included in the meta-analysis.

Fig. 1.

Fig. 1

Open in a new tab

Flow chart of the study selection process used in this systematic review

Quality assessment

Methodological quality assessment with NOS and publication bias analysis were used to assess the quality of the included studies. Among the included studies, 7 scored nine points, 23 scored eight points, 9 scored seven points, and 1 scored six points. Details of each included study’s assessment are shown in Supplementary Table 1.

Outcomes

Among the 40 papers, the incidence of PPCs after general anaesthesia surgeries ranged from 0.28 to 56.82%, and the morbidity of preoperative hypoalbuminaemia ranged from 2.01 to 56.82%. The details are shown in Table 1. The meta-analysis revealed that hypoalbuminaemia significantly increased the risk of PPCs (OR: 2.88, 95% CI 2.50 to 3.32, P < 0.01, I2 = 90%, Fig. 2), and we divided the included studies into four groups. The orthopaedic surgery group (OR: 4.03, 95% CI 3.49 to 4.64, P < 0.01; Figs. 3, 4) included 18 studies, with mild heterogeneity (P = 0.03, I2 = 43%); the abdominal surgery group (OR: 2.48, 95% CI 1.81 to 3.40, P < 0.01; Fig. 5) included 11 studies, with marked heterogeneity (P < 0.01, I2 = 95%); the thoracic surgery group (OR: 1.82, 95% CI 1.46 to 2.26, P < 0.01; Fig. 6) included 6 studies, with mild heterogeneity (P = 0.28, I2 = 23%); and the other surgery group (OR: 2.34, 95% CI 1.66 to 3.29, P < 0.01; Fig. 7) included 4 studies, with marked heterogeneity (P < 0.01, I2 = 87%). In addition, we performed a separate analysis for postoperative pneumonia, which revealed that hypoalbuminaemia also significantly increased the risk of pneumonia (OR: 2.34, 95% CI 2.25 to 2.44, P < 0.01; participants = 394883; studies = 21; I2 = 79%, Fig. 8). In addition, patients with hypoalbuminaemia had increased mortality (OR: 4.19, 95% CI 3.64 to 4.82; participants = 399796; studies = 13; I2 = 68%, Fig. 9), increased risk of readmission (OR: 1.53, 95% CI 1.19 to 1.98; participants = 127096; studies = 8; I2 = 81%, Fig. 9), and increased risk of reoperation (OR: 1.67, 95% CI 1.55–1.80; participants = 320319; studies = 10; I2 = 47%, Fig. 11).

Table 1.

Characteristics of the included studies

Study Country Study type Period Type of surgery Total number PPCs (n) PPCs rate Hypoalbuminaemia (n) Hypoalbuminaemia rate NOS
Orthopaedic surgery
Ahn J 2022 [4 USA R, M 2006–2019 Total shoulder arthroplasty 12,881 89 0.69% 895 6.95% 8
Althoff AD 2020 [5] USA R, M 2008–2015 Proximal humerus fracture surgery 919 50 5.44% 70 7.62% 8
Buzney CD 2022 [6] USA R, M 2010–2014 Posterior cervical fusion 1573 44 0.28% 265 16.85% 8
Fu MC 2014[7] USA R, M 2010–2014 Spinal deformity surgery 2236 68 3.04% 192 8.59% 7
Gu ZT 2010[8] USA R, M 2006–2019 Open rotator cuff repair 3052 10 0.33% 138 4.52% 7
Gupta A 2019 [9] China R, S 2003–2008 Oesophageal squamous cell carcinomas 208 46 22% 21 10.10% 8
Higashikawa T 2020 [10] China R, M 2011–2023 Hip fracture surgery 456 19 4.17% 228 50.00% 9
Kamath AF 2016 [11] USA R, M 2005–2015 Total joint arthroplasty (TJA) 128,412 489 0.38% 5464 4.26% 8
Lee NJ 2017[12] Korea R, S 2005–2021 Elderly hip fractures 1208 47 3.89% 647 53.56% 9
Phan K 2017[13] Korea R, S 2010–2019 Hip fracture 446 26 5.83% 223 50.00% 9
Quan T 2022[14] USA R, M 2007–2014 Acute osteoporotic Vertebral compression fractures 1979 64 3.28% 785 39.67% 8
Ryan SP 2018 [15] China R, S 2019–2020 Primary hip arthroplasty 211 7 3.32% 80 37.91% 8
Shin KH 2020 [16] China R, S 2018 Femoral neck fracture surgery 720 54 7.5% 125 17.36% 8
Tan Y2021[17] USA R, M 2006–2014 Revision total knee arthroplasty 4551 33 0.72% 713 15.67% 8
Tang WY 2024 [18] China R, S 2005–2009 Transoral operation for atlanta-axis disorders 104 23 22.15% 19 18.27% 8
Tian Y 2022[19] Japan R, S 2006–2018 Femoral neck and trochanteric fractures 426 18 4.24%1 139 32.63% 8
Wang Y 2019[20] China R, M 2016–2020 Geriatric hip fracture surgery 1318 73 5.54% 659 50.00% 9
Wu N 2015[21] USA R.M 2005–2010 Anterior cervical discectomy and fusion 1382 17 1.23% 65 4.70% 7
Abdominal surgery
Gebeyehu G 2022 [22] Ethiopia P, M 2021–2022 Abdominal surgery 287 94 32.75% 100 34.84% 8
Inagaki E 2016 [23] USA R, M 2005–2012 Aortic aneurysm repair 27,991 2531 9.04% 5769 20.61% 8
Inokuchi M 2013 [24] Japan R, S 1999–2011 Gastrectomy for gastric cancer 1048 23 2.19% 127 12.12% 8
Jin J 2018 [25] China R, S 2009–2011 Gastrectomy for gastric cancer 1148 140 12.20% 54 4.70% 7
Moghadamyeghaneh Z 2014 [26] USA R.M 2005–2012 Colorectal surgery 88,457 2574 2.91% 16,962 19.18% 7
NguyenGC2019[27] USA R, M 2005–2012 IBD surgery 10,913 501 4.59% 4523 41.45% 9
Oh EJ 2023[28] Korea R, M 2010–2019 Liver transplantation 605 318 52.56% 164 27.11% 8
Perez SC 2023 [29] USA R.M 2015–2019 Revisional/conversion bariatric surgery 58,777 324 0.55% 8455 14.38% 8
Soloff MA 2021 [30] USA R, M 2005.1–2018,12 Laparoscopic hysterectomy 202,069 447 0.22% 4055 2.01% 7
Uppal S 2013[31] USA R.M 2008–2010 Open surgery for gynaecologic malignancies 2110 38 1.80% 279 13.22% 8
Xia L 2017[32] USA R, M 2005–2014 Radical cystectomy for bladder cancer 3790 213 5.62% 328 8.65% 8
Zhang WH 2015 [33] China R, S 2012–2015 Gastrectomy for gastric cancer 719 103 14.33% 103 14.33% 8
Thoracic surgery
Shimakawa T 2014 [34] Japan R, S 2013 Oesophageal cancer 158 28 17.72% 38 24.05% 8
Li P 2018 [35] China R, M 2015–2016 Lung cancer 533 52 9.76% 16 3.00% 7
Liu J 2024 [36] China R, S 2014–2019 Cardiopulmonary bypass 660 375 56.82% 366 55.45% 8
Montazerghaem H 2014 [37] Iran R, S 2009–2012 Cardiac surgery 345 1 0.29% 195 56.52% 6
Rady MY 1997 [38] USA R, S 1993 Cardiovascular surgery 2594 332 12.80% 176 6.78% 7
Ruan H 2022[39] China R, S 2001–2020 Tuberculosis-destroyed lung surgery 116 33 28.45% 32 27.59% 8
Other surgery
Jia Z 2020[40] USA R, M 2007–2016 Emergency surgery 82,725 19,196 23.20% 41,312 49.94% 9
Herzog I 2024 [41] USA R, M 2006–2018 Head and neck free flap reconstruction 3038 381 12.54% 506 16.66% 8
Sciscent BY 2024 [42] USA R, M 2015–2023 Thyroidectomy 4796 75 1.56% 2398 50.00% 9
Yu J 2019[43] Korea R, M 2014–2017 Robot-assisted laparoscopic prostatectomy 2208 682 30.89% 133 6.02% 7
Open in a new tab

RM retrospective multicentre study, RS retrospective single-centre study, PM prospective multicentre study

Fig. 2.

Fig. 2

Open in a new tab

Forest plot of hypoalbuminaemia associated with PPCs after total surgeries

Fig. 3.

Fig. 3

Open in a new tab

Orthopaedic surgery group

Fig. 4.

Fig. 4

Open in a new tab

Funnel plot for the orthopaedic surgery group

Fig. 5.

Fig. 5

Open in a new tab

Abdominal surgery group

Fig. 6.

Fig. 6

Open in a new tab

Thoracic surgery group

Fig. 7.

Fig. 7

Open in a new tab

Other surgery group

Fig. 8.

Fig. 8

Open in a new tab

Forest plot for hypoalbuminaemia associated with pneumonia

Fig. 9.

Fig. 9

Open in a new tab

Forest plot for hypoalbuminaemia associated with mortality

Fig. 11.

Fig. 11

Open in a new tab

Forest plot for hypoalbuminaemia associated with reoperation

We also compared PPCs between the group of patients with preoperative albumin ≤ 30 g/L and the group of patients with preoperative albumin ranging from 30 to 35 g/L (OR: 2.09, 95% CI 1.57–2.78; participants = 52389; studies = 4; I2 = 87%, Fig. 12), which may indicate that the lower the albumin level is, the greater the incidence of PPCs. Due to the high heterogeneity of the abdominal surgery group and other groups, we also conducted separate analyses for the gastric surgery group (OR: 1.79, 95% CI 1.24 to 2.57, P < 0.01, I2 = 0, Fig. 13) and the superficial surgery group(OR: 2.95, 95% CI 2.86 to 3.04, P < 0.01, I2 = 0, Fig. 14).

Fig. 12.

Fig. 12

Open in a new tab

Forest plot for ALB<30 g/L vs. 30–35 g/L

Fig. 13.

Fig. 13

Open in a new tab

Forest plot for gastric surgery group

Fig. 14.

Fig. 14

Open in a new tab

Forest plot for superficial surgery group

Fig. 10.

Fig. 10

Open in a new tab

Forest plot for hypoalbuminaemia associated with readmission

Discussion

To the best of our knowledge, this is the first systematic review and meta-analysis to collect all available data from clinical trials to determine whether hypoalbuminaemia contributes to the risk of PPCs [25, 35]. Preoperative hypoproteinaemia is more likely to occur before major surgery under general anaesthesia, especially in patients who require surgical treatment for malignant tumours. Phan K et al. [13] suggested that hypoalbuminaemia may be related to malnutrition, and compared with BMI [6, 21], preoperative hypoalbuminaemia is more likely to be associated with postoperative complications. Jia Z et al. [40] used different nutritional assessment methods to predict postoperative complications and reported that hypoalbuminaemia was not a significant factor in patients with very severe hypoalbuminaemia (albumin < 20 g/L). Given the results of this study, nutritional status is an important preoperative risk factor, and malnutrition suggested by hypoalbuminaemia should be managed prior to surgery. That may be related to the profound impact of hypoalbuminemia on the pathogenesis of respiratory diseases through multiple mechanisms, including reducing tumor pressure, damaging anti-inflammatory and antioxidant capabilities, and so on. The higher OR value in orthopedic surgery may be related to the relatively high proportion of elderly patients undergoing orthopedic surgery and the limitation of posture during the perioperative period [44].

Moreover, some studies have suggested that hypoproteinaemia on the first day after surgery and a reduction in the serum albumin and prealbumin levels are related to postoperative complications [35, 45, 46]. The included studies did not explicitly indicate whether an intervention was performed for preoperative hypoproteinaemia. There have been several prospective studies evaluating whether preoperative albumin infusion leads to a reduction in postoperative complications, but the results have been negative[47]. This may suggest that we need to provide nutritional support rather than correct low serum albumin values. More prospective studies are needed to explore the relationship between correcting the preoperative nutritional status of patients and reducing postoperative pulmonary complications.

PPCs are prevalent in patients after major surgeries and are associated with prolonged mechanical ventilation, extended hospital and ICU stays, and increased mortality and tracheotomy rates. Jeong BH et al.[48] developed a PPC risk model to predict PPCs, which involves preoperative serum albumin levels. The specific mechanism by which hypoproteinaemia leads to increased postoperative complications is still not completely clear, and the definition of PPCS in the included studies also varied, so more prospective studies are needed to explore its pathogenesis.

Limitations

This meta-analysis had several limitations. Importantly, all the studies included in this analysis were retrospective in nature. This retrospective design may introduce inherent biases and limitations, such as selection bias and limited control over confounding variables.And only two studies [16, 22]conducted propensity score matching for confounding factors such as COPD and DM. In addition, the exact demographic data of patients with hypoalbuminaemia and normal levels could not be obtained from these studies. The heterogeneity of the trial design and outcome measures used and the variation in surveillance fidelity and diagnostic classifications for PPC outcomes present problems for evidence synthesis.

Abdominal surgery resulted in greater heterogeneity than other surgical methods due to its wide spectrum of procedures (from simple to highly complex), significant baseline variability, technical diversity (open/minimally invasive/surgeon-dependent techniques), and broad postoperative complications (infections/fistulae/organ dysfunction). In the abdominal surgery group and other surgery groups, we anticipated heterogeneity and used random effect model analysis and trial sequential analysis to provide conservative estimates of treatment effects and reduce false positives.

Another source of heterogeneity was that the time of diagnosis of hypoproteinaemia was not consistent among the studies. Inagaki E et al. [23] reported the time of diagnosis as being within 24 h before surgery, Montazerghem H et al. [37] considered it to be upon admission, and most other investigators did not specify the specific time of diagnosis. Furthermore, the sources of heterogeneity may also arise from different definitions of PPCs, anesthesia protocols, and surgical populations.

As a composite measure, PPCs do not convey the precise nature of complications that are experienced by patients. For this reason, we specifically evaluated the individual outcomes of pneumonia, mortality, readmission, and reoperation in our meta-analyses. However, these analyses were based on studies referring to PPCs, and the conclusions may not be applicable to all operations. Meanwhile, it is expected that more prospective studies will emerge in the future to evaluate whether correcting hypoalbuminemia before surgery can reduce postoperative complications.

Conclusions

In summary, this systematic review and meta-analysis provided strong evidence that hypoalbuminaemia increases the incidence of PPCs and pneumonia and that hypoalbuminaemia also increases the mortality of patients undergoing general anaesthesia during surgery. These results emphasize the importance of proper evaluation and management of hypoalbuminaemia in this patient population to improve clinical outcomes and reduce the morbidity of PPCs and mortality. Additionally, these findings have important implications for clinical practice, emphasizing the need to evaluate and manage hypoalbuminaemia before general anaesthesia for surgery, which highlights the importance of preoperative and postoperative comprehensive nutritional assessment [49, 50]. The monitoring of postoperative pulmonary complications in patients with preoperative hypoalbuminaemia is emphasized.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1 (228.5KB, docx)
Supplementary Material 2 (2.8KB, csv)
Supplementary Material 3 (32.7KB, pdf)

Acknowledgements

Not applicable.

Abbreviations

PPCs

Postoperative pulmonary complications

CI

Confidence interval

OR

Odds ratio

ALB

Albumin

Author contributions

Authorship provides credit for a researcher’s contributions to a study and carries accountability. This systematic review and meta-analysis was registered at the International Prospective Register of Systematic Reviews (Number CRD42024540493). Xi Wang wrote the main manuscript, Fang Xu made design of the work; Hong Tang wrote the analysis of the research.Mingke Zheng wrote the Search strategy part of the research.

Funding

Screening and mechanism of inflammation–immune–metabolism targets in acute respiratory distress syndrome: “Overall rationing” program of Chongqing Talents Program, cstc2022ycjh-bgzxm0131.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Deng T, Song J, Tuo J, Wang Y, Li J, Ping Suen LK, Liang Y, Ma J, Chen S. Incidence and risk factors of pulmonary complications after lung cancer surgery: a systematic review and meta-analysis. Heliyon. 2024;10(12):e32821. 10.1016/j.heliyon.2024.e32821. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Odor PM, Bampoe S, Gilhooly D, Creagh-Brown B, Moonesinghe SR. (2020). Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ (Clinical research ed.), 368, m540. 10.1136/bmj.m540 [DOI] [PMC free article] [PubMed]
  • 3.Singh P, Gossage J, Markar S, Pucher PH, Wickham A, Weblin J, Chidambaram S, Bull A, Pickering O, Mythen M, Maynard N, Grocott M, Underwood T, AUGIS/POQI Pulmonary Consensus Group. Association of upper Gastrointestinal surgery of great Britain and Ireland (AUGIS)/Perioperative quality initiative (POQI) consensus statement on intraoperative and postoperative interventions to reduce pulmonary complications after oesophagectomy. Br J Surg. 2022;109(11):1096–106. 10.1093/bjs/znac193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Ahn J, Chang JS, Kim JW. Postoperative pneumonia and aspiration pneumonia following elderly hip fractures. J Nutr Health Aging. 2022;26(7):732–8. 10.1007/s12603-022-1821-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Althoff AD, Ignozzi AJ, Bell JE, Werner BC. Pre-operative hypoalbuminemia is associated with complications following proximal humerus fracture surgery: an analysis of 919 patients. HSS Journal: Musculoskelet J Hosp Special Surg. 2020;16(Suppl 2):436–42. 10.1007/s11420-020-09804-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Buzney CD, Zhong H, Gulotta LV, Memtsoudis SG, Liu J. Is there synergistic effect between obesity and hypoalbuminemia on postoperative outcomes among primary total shoulder arthroplasty recipients? HSS J Musculoskelet J Hosp Special Surg. 2022;18(4):504–11. 10.1177/15563316221083251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Fu MC, Buerba RA, Grauer JN. Preoperative nutritional status as an adjunct predictor of major postoperative complications following anterior cervical discectomy and fusion. Clin Spine Surg. 2016;29(4):167–72. 10.1097/BSD.0000000000000181. [DOI] [PubMed] [Google Scholar]
  • 8.Gu ZT, Dai JQ, Yin QS, Wu ZH, Zheng GD. Zhonghua Wai Ke Za Zhi. Chin J Surg. 2010;48(22):1714–7. [PubMed] [Google Scholar]
  • 9.Gupta A, Upadhyaya S, Cha T, Schwab J, Bono C, Hershman S. Serum albumin levels predict which patients are at increased risk for complications following surgical management of acute osteoporotic vertebral compression fractures. Spine Journal: Official J North Am Spine Soc. 2019;19(11):1796–802. 10.1016/j.spinee.2019.06.023. [DOI] [PubMed] [Google Scholar]
  • 10.Higashikawa T, Shigemoto K, Goshima K, Usuda D, Okuro M, Moriyama M, Inujima H, Hangyou M, Usuda K, Morimoto S, Matsumoto T, Takashima S, Kanda T, Sawaguchi T. Risk factors for the development of aspiration pneumonia in elderly patients with femoral neck and trochanteric fractures: a retrospective study of a patient cohort. Medicine. 2020;99(7):e19108. 10.1097/MD.0000000000019108. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Kamath AF, Nelson CL, Elkassabany N, et al. Low albumin is a risk factor for complications after revision total knee arthroplasty. J KNEE SURG. 2016;30(3):269–75. 10.1055/s-0036-1584575. [DOI] [PubMed] [Google Scholar]
  • 12.Lee NJ, Kothari P, Kim JS, Phan K, Di Capua J, Shin J, Cho SK, Phan K, Kim JS, Xu J, Di Capua J, Lee NJ, Kothari P, Vig KS, Dowdell J, Cho SK. Nutritional insufficiency as a predictor for adverse outcomes in adult spinal deformity surgery. Global Spine J. 2018;8(2):164–171. 10.1177/2192568217708777. [DOI] [PMC free article] [PubMed]
  • 13.Phan K, Kim JS, Xu J, Di Capua J, Lee NJ, Kothari P, Vig KS, Dowdell J, Cho SK (2018) Nutritional Insufficiency as a Predictor for Adverse Outcomes in Adult Spinal Deformity Surgery. Global spine journal, 8(2), 164–171. 10.1177/2192568217708777 [DOI] [PMC free article] [PubMed]
  • 14.Quan T, Lopez JD, Chen FR, Manzi JE, Best MJ, Srikumaran U, Zimmer ZR. A retrospective study evaluating the association between hypoalbuminemia and postoperative outcomes for patients receiving open rotator cuff repair. J Orthop. 2022;30:88–92. 10.1016/j.jor.2022.02.023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Ryan SP, Politzer C, Green C, Wellman S, Bolognesi M, Seyler T. Albumin versus American society of anesthesiologists score: which is more predictive of complications following total joint arthroplasty? Orthopedics. 2018;41(6):354–62. 10.3928/01477447-20181010-05. [DOI] [PubMed] [Google Scholar]
  • 16.Shin KH, Kim JJ, Son SW, Hwang KS, Han SB. Early postoperative hypoalbuminaemia as a risk factor for postoperative pneumonia following hip fracture surgery. Clin Interv Aging. 2020;15:1907–15. 10.2147/CIA.S272610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Tan Y, Jiang L, Liu H, Pan Z, Wang H, Chen L. The effect of preoperative hypoalbuminemia on complications after primary hip arthroplasty. J Orthop Surg Res. 2021;16(1):562. 10.1186/s13018-021-02702-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Tang W, Yao W, Wang W, Ding W, Ni X, He R. Association between admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study. BMC Musculoskelet Disord. 2024;25(1):234. 10.1186/s12891-024-07336-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Tian Y, Zhu Y, Zhang K, Tian M, Qin S, Li X. Relationship between preoperative hypoalbuminemia and postoperative pneumonia following geriatric hip fracture surgery: a propensity-score matched and conditional logistic regression analysis. Clin Interv Aging. 2022;17:495–503. 10.2147/CIA.S352736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Wang Y, Li X, Ji Y, Tian H, Liang X, Li N, Wang J. Preoperative serum albumin level as a predictor of postoperative pneumonia after femoral neck fracture surgery in a geriatric population. Clin Interv Aging. 2019;14:2007–16. 10.2147/CIA.S231736. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Wu N, Chen G, Hu H, Pang L, Chen Z. Low pretherapeutic serum albumin as a risk factor for poor outcome in esophageal squamous cell carcinomas. Nutr Cancer. 2015;67(3):481–5. 10.1080/01635581.2015.1004726. [DOI] [PubMed] [Google Scholar]
  • 22.Gebeyehu G, Eshetu A, Aweke S. Incidence and associated factors of postoperative pulmonary complications after abdominal surgery in the public hospital, Addis Ababa, Ethiopia. Anesthesiol Res Pract. 2022: 8223903. 10.1155/2022/8223903 [DOI] [PMC free article] [PubMed]
  • 23.Inagaki E, Farber A, Eslami MH, Kalish J, Rybin DV, Doros G, Peacock MR, Siracuse JJ. Preoperative hypoalbuminemia is associated with poor clinical outcomes after open and endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2017;66(1):53–e631. 10.1016/j.jvs.2016.10.110. [DOI] [PubMed] [Google Scholar]
  • 24.Inokuchi M, Kojima K, Kato K, Sugita H, Sugihara K. Risk factors for post-operative pulmonary complications after gastrectomy for gastric cancer. Surg Infect. 2014;15(3):314–21. 10.1089/sur.2013.031. [DOI] [PubMed] [Google Scholar]
  • 25.Jin J, Deng J, Liang H, Sun C, Guo X, Guo J, Bai H, Liu H, Zhang N. Zhonghua Wei Chang Wai Ke Za zhi = chinese. J Gastrointest Surg. 2018;21(1):53–60. [PubMed] [Google Scholar]
  • 26.Moghadamyeghaneh Z, Hwang G, Hanna MH, Phelan MJ, Carmichael JC, Mills SD, Pigazzi A, Dolich MO, Stamos MJ. Even modest hypoalbuminemia affects outcomes of colorectal surgery patients. Am J Surg. 2015;210(2):276–84. 10.1016/j.amjsurg.2014.12.038. [DOI] [PubMed] [Google Scholar]
  • 27.Nguyen GC, Du L, Chong RY, Jackson TD. Hypoalbuminaemia and postoperative outcomes in inflammatory bowel disease: the NSQIP surgical cohort. J Crohn’s Colitis. 2019;13(11):1433–8. 10.1093/ecco-jcc/jjz083. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Oh EJ, Kim J, Kim BG, Han S, Ko JS, Gwak MS, Kim GS, Choi EA, Kang J, Park HY. Intraoperative factors modifying the risk of postoperative pulmonary complications after living donor liver transplantation. Transplantation. 2023;107(8):1748–55. 10.1097/TP.0000000000004544. [DOI] [PubMed] [Google Scholar]
  • 29.Perez SC, Alessi IG, Wheeler AA. Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis. Surg Obes Relat Diseases: Official J Am Soc Bariatr Surg. 2023;19(6):555–61. 10.1016/j.soard.2022.12.010. [DOI] [PubMed] [Google Scholar]
  • 30.Soloff MA, Vargas MV, Wei C, Ohnona A, Tyan P, Gu A, Georgakopoulos B, Thomas CA, Quan T, Barishansky S, Moawad G. Malnutrition is associated with poor postoperative outcomes following laparoscopic hysterectomy. JSLS: J Soc Laparoendoscopic Surg. 2021;25(1):e202000084. 10.4293/JSLS.2020.00084. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Uppal S, Al-Niaimi A, Rice LW, Rose SL, Kushner DM, Spencer RJ, Hartenbach E. Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies. Gynecol Oncol. 2013;131(2):416–22. 10.1016/j.ygyno.2013.08.011. [DOI] [PubMed] [Google Scholar]
  • 32.Xia L, Taylor BL, Guzzo TJ. Characteristics and associated factors of postoperative pulmonary complications in patients undergoing radical cystectomy for bladder cancer: A National surgical quality improvement program study. Clin Genitourin Cancer. 2017;15(6):661–9. 10.1016/j.clgc.2017.04.009. [DOI] [PubMed] [Google Scholar]
  • 33.Zhang WH, Chen XZ, Yang K, Liu K, Guo DJ, Wang W, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Risk factors and survival outcomes for postoperative pulmonary complications in gastric cancer patients. Hepatogastroenterology. 2015;62(139):766–72. [PubMed] [Google Scholar]
  • 34.Shimakawa T, Asaka S, Sagawa M, Shimazaki A, Yamaguchi K, Usui T, Yokomizo H, Shiozawa S, Yoshimatsu K, Katsube T, Naritaka Y. Gan to Kagaku Ryoho. Cancer Chemother. 2014;41(10):1301–3. [PubMed] [Google Scholar]
  • 35.Li P, Li J, Lai Y, Wang Y, Wang X, Su J, Che G. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study. J Thorac Disease. 2018;10(10):5755–63. 10.21037/jtd.2018.09.113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Liu J, Li X, Xie W, Wang Y, Xu Z, Bai YX, Zhou Q, Wu Q. Risk factors and short-term outcomes of postoperative pulmonary complications in elderly patients after cardiopulmonary bypass. Clin Interv Aging. 2024;19:31–9. 10.2147/CIA.S439601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Montazerghaem H, Safaie N, Samiei Nezhad V. Body mass index or serum albumin levels: which is further prognostic following cardiac surgery? J Cardiovasc Thorac Res. 2014;6(2):123–6. 10.5681/jcvtr.2014.026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Rady MY, Ryan T, Starr NJ. Clinical characteristics of preoperative hypoalbuminemia predict outcome of cardiovascular surgery. JPEN J Parenter Enteral Nutr. 1997;21(2):81–90. 10.1177/014860719702100281. [DOI] [PubMed] [Google Scholar]
  • 39.Ruan H, Li Y, Wang Y, Liu F, Hou D, Gong C, Wang J, Liu Z. Risk factors for respiratory failure after tuberculosis-destroyed lung surgery and increased dyspnea score at 1-year follow-up. J Thorac Disease. 2022;14(10):3737–47. 10.21037/jtd-22-610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Jia Z, El Moheb M, Nordestgaard A, Lee JM, Meier K, Kongkaewpaisan N, Han K, Hechi E, Mendoza MW, King A, Fagenholz D, Saillant P, Rosenthal N, Velmahos M, G., Kaafarani HMA. The geriatric nutritional risk index is a powerful predictor of adverse outcome in the elderly emergency surgery patient. J Trauma Acute Care Surg. 2020;89(2):397–404. 10.1097/TA.0000000000002741. [DOI] [PubMed] [Google Scholar]
  • 41.Herzog I, Panchal D, Sikder S, Park JB, Mendiratta D, Mansukhani PA, Lee ES. Malnutrition in head and neck free flap reconstruction as a predictor of adverse outcomes. Ann Plast Surg. 2024;92(4S Suppl 2):S251–4. 10.1097/SAP.0000000000003868. [DOI] [PubMed] [Google Scholar]
  • 42.Sciscent BY, Eberly HW, Lorenz FJ, Truong N, Goldenberg D, Goyal N. Preoperative serum albumin as predictor of outcomes after thyroidectomy. OTO Open. 2024;8(1):e114. 10.1002/oto2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Yu J, Park JY, Kim DH, Kim S, Hwang JH, Seo H, Kim YK. Incidence and risk factors of pulmonary complications after robot-assisted laparoscopic prostatectomy: a retrospective observational analysis of 2208 patients at a large single center. J Clin Med. 2019;8(10):1509. 10.3390/jcm8101509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, Lee JW, Henderson WG, Moss A, Mehdiratta N, Colwell MM, Bartels K, Kolodzie K, Giquel J, Melo V, M. F. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the perioperative research network investigators. JAMA Surg. 2017;152(2):157–66. 10.1001/jamasurg.2016.4065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Admass BA, Ego BY, Tawye HY, Ahmed SA. Post-operative pulmonary complications after thoracic and upper abdominal procedures at referral hospitals in Amhara region, ethiopia: a multi-center study. Front Surg. 2023;10:1177647. 10.3389/fsurg.2023.1177647. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Maruyama S, Okamura A, Kanie Y, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Kumagai K, Watanabe M. C-reactive protein to prealbumin ratio: a useful inflammatory and nutritional index for predicting prognosis after curative resection in esophageal squamous cell carcinoma patients. Langenbeck’s Archives Surg. 2022;407(5):1901–9. 10.1007/s00423-022-02508-6. [DOI] [PubMed] [Google Scholar]
  • 47.Schaller SJ, Fuest K, Ulm B, Schmid S, Bubb CAB, Eckstein HH, von Eisenhart-Rothe R, Friess H, Kirchhoff C, Luppa P, Blobner M, Jungwirth B. Goal-directed perioperative albumin substitution versus standard of care to reduce postoperative complications: a randomized clinical trial (SuperAdd trial). Ann Surg. 2024;279(3):402–9. 10.1097/SLA.0000000000006030. [DOI] [PubMed] [Google Scholar]
  • 48.Eom JS, Yoo H, Song W, Han S, Lee KJ, Jeon K, Um SW, Koh WJ, Suh GY, Chung MP, Kim H, Kwon OJ, Woo S, Park HY. Development of a prediction rule for estimating postoperative pulmonary complications. PLoS ONE. 2014;9(12):e113656. 10.1371/journal.pone.0113656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale RG, Waitzberg D, Bischoff SC, Singer P. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745–61. 10.1016/j.clnu.2021.03.031. [DOI] [PubMed] [Google Scholar]
  • 50.Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, Weiss K, Owens DK, Aronson M, Barry P, Casey DE Jr, Cross JT Jr, Fitterman N, Sherif KD, Weiss KB. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American college of physicians. Ann Intern Med. 2006;144(8):575–80. 10.7326/0003-4819-144-8-200604180-00008. Clinical Efficacy Assessment Subcommittee of the American College of Physicians. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (228.5KB, docx)
Supplementary Material 2 (2.8KB, csv)
Supplementary Material 3 (32.7KB, pdf)

Data Availability Statement

No datasets were generated or analysed during the current study.

Articles from BMC Anesthesiology are provided here courtesy of BMC

RESOURCES