Hypoalbuminemia and increased surgical risk: some new thoughts

Since 2015, three large studies focusing on patients with severe obesity and those undergoing bariatric surgery procedures have added to the expanding list of studies extending over the past 40 years, demonstrating that hypoalbuminemia is a strong predictor of surgical morbidity and mortality. 1 Dietch Z. Guidry C. Davies S. Sawyer R. Hypoalbuminemia is disproportionately associated with adverse outcomes in obese elective surgical patients. Surg Obes Relat Dis. 2015; 11 (Jul-Aug): 912-918https://doi.org/10.1016/j.soard.2014.10.010 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar , 2 Hart A. Sun Y. Titcomb T. et al. Association between preoperative serum albumin levels with risk of death and postoperative complications after bariatric surgery: a retrospective cohort study. Surg Obes Relat Dis. 2022; 18 (Jul): 928-934https://doi.org/10.1016/j.soard.2022.04.006 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar , 3 Perez S. Alessi I. Wheeler A. Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis. Surg Obes Relat Dis. 2023; 19 (Jun): 555-561https://doi.org/10.1016/j.soard.2022.12.010 Abstract Full Text Full Text PDF Scopus (2) Google Scholar The discussions in these studies as well as the editorial comments 4 Gagner M. Comment on: Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis. Surg Obes Relat Dis. 2023; 19 (Jun): 561-562https://doi.org/10.1016/j.soard.2023.02.004 Abstract Full Text Full Text PDF Scopus (0) Google Scholar reflect the teachings derived from the early studies demonstrating the common presence of protein-calorie malnutrition with associated immune alterations among hospitalized patients 5 Bistrian B.R. Blackburn G.L. Hallowell E. Heddle R. Protein status of general surgical patients. JAMA. 1974; 230: 858-860 Crossref PubMed Scopus (631) Google Scholar ,6 Bistrian B.R. Blackburn G.L. Scrimshaw N.S. Flatt J.P. Cellular immunity in semistarved states in hospitalized adults. Am J Clin Nutr. 1975; 28 (Oct): 1148-1155 Abstract Full Text PDF PubMed Scopus (206) Google Scholar and techniques for nutritional assessment. 7 Blackburn G. Bistrian B. Maini B. Schlamm H. Smith M. Nutritional and metabolic assessment of the hospitalized patient. J Parenter Ent Nutr. 1977; 1: 11-21 Crossref PubMed Google Scholar This has led to the widely held belief that hypoalbuminemia is a marker of undernutrition which explains its importance in predicting surgical risk.