Serum Albumins How Useful as a Predictor of Operatlwe Risk?

摘要

/ enjoyed Dr Gregory Rutecki's Top Papers of the Month column "The Ritual of Preoperative Consultation: Essential or Superfluous?" (CONSULTANT, June 2011, page 361), in which he mentioned that for low-risk procedures, such as cataract surgery, routine preoperative medical testing does not benefit patients or improve outcomes. About 2 months ago I went through a preoperative evaluation before I had cataract surgery. The operation took 5 to 6 minutes, and I was awake. As for preoperative evaluation before more complicated surgery, I would like to call Dr Rutecki's attention to a study that looked at preoperative serum albumin levels as a predictor of surgical risk.1 Included in the study were 54,215 major noncardiac non-emergent cases at 44 tertiary care Veterans Affairs CVA) medical centers. The investigators found that a decrease in serum albumin from concentrations greater than 4.6 g/L to less than 2.1 g/L was associated with an exponential increase in mortality rates from 1% to 29%, and in the morbidity rates from 10% to 65%. They concluded that serum albumin concentration is a better predictor of surgical outcomes than many other preoperative patient characteristics. It is a relatively low-cost test that should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes.