O1103: Low Preoperative Albumin Levels Are Associated with Increased Surgical Complications in Children with Cancer: A National Analysis

Background: Perioperative nutrition is a critical component of appropriate healing and recovering from surgery. In children with cancer, wound healing following surgical resection is also may be worsened by prior and/or subsequent chemotherapy and radiation, making preoperative nutrition especially critical. We sought to identify perioperative risk in children with cancer with low preoperative albumin levels undergoing surgical intervention.

Methods: We queried the National Surgical Quality Improvement Program 2015-2019 datasets for children with primary diagnosis of renal malignancy and hepatic malignancy undergoing surgical resection. Postoperative outcomes including wound complications, infectious etiologies, bleeding, thrombosis, reoperation, readmission were evaluated for comparative risk between patients with low albumin (albumin < 3.0 g /dL) and normal albumin (albumin>3.0 g/dL) based on laboratory data within 30 days before their surgical procedure. Univariate analysis and multivaraible logistic regression was conducted to identify perioperative risk in patients with low albumin.

Results:

Results: We identified 360 children with primary diagnosis of hepatic malignancy and 896 children with primary diagnosis of renal malignancy undergoing surgical resection. Normal preoperative albumin levels (albumin>3g/dL) were present in 897 patients (92.03%); 77 children (7.97%) had low albumin levels, and 282 had missing albumin levels. Patients with renal or hepatic malignancy diagnosis and low albumin levels were more likely to experience postoperative dehiscence (2.60% vs. 0.56%), need for TPN at time of discharge (7.79% vs. 2.68%), postoperative bleeding/transfusion (61.04% vs. 39.69%), unplanned reoperation (11.69% vs. 5.57%), and unplanned readmission (22.08% vs 12.7%) based on univariate analysis (all p>0.05). Of these variables postoperative bleeding (OR 2.117 [95%CI 1.282-3.495]; p=0.0034), need for parenteral nutrition at discharge (OR 3.071 [95%CI 1.135-8.312]; p=0.0272) and unplanned readmission (OR 1.913 [95%CI 1.065-3.435]; p=0.0300) were each associated with low preoperative albumin levels.

Conclusion:

Conclusion: Our finding that low preoperative albumin is associated with important perioperative outcomes, including wound dehiscence, bleeding and transfusion, and need for unplanned reoperation, suggests that more attention should be focused on perioperative nutritional status of children with cancer undergoing major resections. Additional value may be gained from more acute measures of perioperative nutrition.