Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy Aoife M. Ryan & Aine Hearty & Ruth S. Prichard & Aileen Cunningham & Suzanne P. Rowley & John V. Reynolds Published online: 8 August 2007 # 2007 The Society for Surgery of the Alimentary Tract Abstract Objective Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute albumin level on the first postoperative day was of value in predicting in-hospital complications. Methods A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and 2005 was performed. Patients who had pre and postoperative (days 1, 3, and 7) serum albumin levels measured were included in the study. Patients were subdivided into three postoperative albumin categories <20 g/l, 20–25 g/l, >25 g/l. Logistic regression analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level. Results Patients with an albumin of less than 20 g/l on the first postoperative day were twice as likely to develop postoperative complications than those with an albumin of greater than 20 g/l (54 vs 28% respectively, p <0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome (22 vs 5%, p < 0.001), respiratory failure (27 vs 8%, p <0.01) and in-hospital mortality (27 vs 6% (p <0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications (odds ratios, 0.89: 95%; confidence intervals, 0.83–0.96; p <0.005). In addition, albumin <20 g/l on the first postoperative day was associated with the need for further surgery and a return to ICU. Conclusion Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes. Keywords Albumin . Esophagectomy . Morbidity . Mortality . Complications Introduction Esophagectomy is associated with a significant risk of morbidity and mortality rate, the largest prospective outcome cohort in the literature reported a morbidity rate of 50% and mortality rate of 10% 1 . Several preoperative risk factors have been identified, including advancing age, comorbid disease, preoperative chemoradiotherapy, low body mass index (BMI) and decreased functional status 2–4 . In addition to preoperative factors, the early course postoperatively may help predict short-term outcomes. Numerous studies have looked at immune perturbations postoperatively as a predictor of systemic inflammatory response syndrome (SIRS) and sepsis 5 . Esophagectomy induces profound changes in the endocrine, neuroendocrine and immune system as well as significant changes in organ J Gastrointest Surg (2007) 11:1355–1360 DOI 10.1007/s11605-007-0223-y A. M. Ryan : R. S. Prichard : A. Cunningham : S. P. Rowley : J. V. Reynolds (*) University Department of Clinical Surgery, Trinity Center for Health Sciences, St. James’ s Hospital, Dublin, Ireland e-mail: reynoljv@tcd.ie A. Hearty Department of Clinical Medicine, Trinity Center for Health Sciences, St. James’ s Hospital, Dublin, Ireland