Table 2.
Outcomes and Conclusions of Albumin Studies
| Author Name | Outcomes | Conclusions |
| Alfargieny et al2 | SSI | Perioperative albumin was a notable risk factor for SSI |
| Bohl et al3 | 30-day postoperative outcomes—wound dehiscence, deep vein thrombosis, and other | Patients with hypoalbuminemia had a higher risk of SSI, pneumonia, extended length of stay, and readmission |
| Bohl et al10 | Aseptic indications for revision arthroplasty, septic indications for revision arthroplasty, and PJI | Patients with hypoalbuminemia were three times as likely to have septic indication for revision arthroplasty as compared to patients with normal albumin levels. For those with aseptic indications for revision arthroplasty, patients with hypoalbuminemia had a risk of developing a PJI twice as great as those with normal albumin levels. |
| Courtney et al11 | Postoperative complications: cardiac, pulmonary, and other | Hypoalbuminemic patients were more likely to have a postoperative complication. Morbidly obese patients were more likely to be hypoalbuminemic than nonmorbidly obese patients. When comparing hypoalbuminemic morbidly obese patients with hypoalbuminemic nonmorbidly obese patients, no differences were observed in complication rates. When comparing morbidly obese patients with normal albumin to nonmorbidly obese patients, no differences were observed in complication rates. |
| Cross et al7 | N/A | N/A |
| Fu et al12 | Postoperative complications: cardiac (ie, myocardial infarction or cardiac arrest), septic (ie, sepsis or septic shock), and other | Malnutrition incidence increased markedly from obese I to obese III patients and was a stronger and more consistent predictor of complications after THA than was obesity. |
| Fu et al5 | Postoperative complications: wound (ie, superficial infection, deep SSI, organ space surgical site infection, or wound dehiscence) and other | Hypoalbuminemia was a more consistent independent predictor of complications after TKA than was obesity. |
| Gherini et al8 | Delayed wound healing | Only preoperative serum transferrin levels showed notable value in predicting which patients would have delayed wound healing. None of the other serologic variables, including serum albumin and TLC, proved to be a predictor of delayed wound healing. |
| Greene et al1 | Persistent serous drainage and wound dehiscence | Low albumin and low transferrin, independently or concurrently, were associated with more postoperative complications. |
| Gunningberg et al13 | Surgical wound infection | Low preoperative S-albumin was identified as the only notable predictor for surgical wound infection. |
| Huang et al14 | Complications: cardiovascular, neurovascular, and other | The incidence of complications was higher in malnourished patients than in nonmalnourished patients, regardless of whether they were obese. Renal complications were the most common complication experienced by malnourished patients and occurred at markedly higher rates than for nonmalnourished patients. Age was not a notable factor in developing malnutrition, but the incidence increased steadily through age 70. |
| Kamath et al15 | Unplanned postoperative intensive care unit admission | Patients with low albumin had a higher risk of unplanned postoperative intensive care unit admission. |
| Kamath et al6 | Mortality, superficial wound infection, and other | Patients in the low serum albumin group were statistically more likely to develop deep SSI, organ space SSI, and other complications. |
| Kim et al16 | Incidence of acute kidney injury, hospital stay, and overall mortality | Low albumin within two postoperative days was an independent risk factor for acute kidney injury and increased length of hospital stay in patients undergoing TKA. |
| Lavernia et al17 | Complications, resource consumption, length of stay, and number of in-hospital medical or surgical consults obtained | Patients with low albumin levels had higher charges, higher severity of illness, and longer length of stay. |
| Marín et al9 | Delayed wound healing | Preoperative lymphocyte count of less than 1500 cells/mm3 was associated with a three times greater frequency of healing complications, whereas preoperative serum albumin and transferrin levels had no notable predictive value. |
| Mednick et al18 | Readmission | The risk of readmission after THA increased with growing preoperative comorbidity burden. It specifically increased in patients with a body mass index of greater than or equal to 40 kg/m2, a history of corticosteroid use, and low preoperative serum albumin and in patients with postoperative SSI, a thromboembolic event, and sepsis. |
| Morey et al19 | Wound complications (ie, drainage, hemarthrosis, skin necrosis, and dehiscence) or PJI | Findings called into question the values of serum albumin level and TLC as a surrogate of malnutrition for predicting wound complications after TKA. |
| Nelson et al4 | Mortality, superficial wound infection, and other | Morbid obesity was not independently associated with most perioperative complications measured by the ACS-NSQIP and was associated only with increases in progressive renal insufficiency, superficial SSI, and sepsis among the 21 perioperative variables measured. Low serum albumin was associated with increased mortality and multiple additional major perioperative complications after TKA. Low serum albumin, more so than morbid obesity, was associated with major perioperative complications. |
| Nelson et al20 | Major complications, wound infections, and systemic infections | ORs increased or trended higher for all complications for albumin levels under 3.0 g/dL |
| Nicholson et al21 | Length of stay, intraoperative complications, and postoperative complications | The rate of malnourishment was marked higher in patients having trauma-related surgery than in those having elective surgery. Malnourished patients were at greater risk of prolonged hospital stay. |
| Nussenbaum et al22 | SSI, return to operating room, and other | The investigators saw a statistically significant decrease in both SSI and total complications after the implementation of preoperative screening criteria for elective TKA and THA. No single criterion was found to individually predict the complication and infection reductions. |
| Rai et al23 | Wound healing categories: normal/healthy scar after suture removal, delayed wound healing, and infected | Preoperative nutritional status was among several factors governing postoperative wound healing. Preoperative malnourishment as assessed by the low levels of serum albumin, serum transferrin, and TLC did not necessarily lead to delayed wound healing. Although several authors found high incidences of delayed wound healing and wound infection in malnourished patients, there were none in this study. The risk imposed by malnutrition on wound healing can be modified by surgeon-dependent factors. |
| Savio et al24 | Length of stay | Preoperative serum albumin was the only preoperative serum test associated with length of stay. Albumin was inversely related with length of stay. |
| Walls et al25 | Mortality, superficial incisional SSI, and other | Hypoalbuminemia was a notable risk factor for mortality and major morbidity among THA patients, whereas morbid obesity was only associated with an increased risk of superficial SSI. |
| Yi et al26 | Septic revision and aseptic revision | The presence of one or more laboratory parameters suggestive of malnutrition (ie, low albumin, low transferrin, and low lymphocyte count), although common in both normal weight and overweight patients, was independently associated with both chronic PJI and the development of an acute postoperative infection after an aseptic revision arthroplasty. |
ACS-NSQIP = the American College of Surgeons National Surgical Quality Improvement Program; OR = odds ratio; PJI = periprosthetic joint infection; SSI = surgical site infection; THA = total hip arthroplasty; TLC = total lymphocyte count.