Protein as a preoperative predictor - Impact of hypoalbuminemia on 30-day outcomes of breast reduction surgery

Samuel Knoedler; Felix J Klimitz; Fortunay Diatta; Filippo A G Perozzo; Giuseppe Sofo; Michael Alfertshofer; Mario Cherubino; Horacio Mayer; Adriana C Panayi; Bong-Sung Kim; Bohdan Pomahac; Martin Kauke-Navarro

doi:10.1016/j.bjps.2024.11.011

Protein as a preoperative predictor - Impact of hypoalbuminemia on 30-day outcomes of breast reduction surgery

J Plast Reconstr Aesthet Surg. 2024 Nov 20:100:144-152. doi: 10.1016/j.bjps.2024.11.011. Online ahead of print.

Authors

Affiliations

¹ Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
² Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic, and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.
³ Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
⁴ Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
⁵ Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
⁶ Department of Plastic, Reconstructive and Aesthetic Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
⁷ Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina.
⁸ Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic, and Hand Surgery, University of Heidelberg, Ludwigshafen, Germany.
⁹ Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
¹⁰ Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA. Electronic address: kauke-navarro.martin@yale.edu.

PMID: 39615141
DOI: 10.1016/j.bjps.2024.11.011

Abstract

Background: Hypoalbuminemia, a biomarker of malnutrition, has been associated with adverse surgical outcomes;, however, its impact on breast reduction surgery is not yet well-documented.

Methods: We queried the American college of surgeons national surgical quality improvement program database to identify patients who underwent breast reduction surgery between 2008 and 2022. Patients were grouped by preoperative normal albumin levels (≥3.5 g/dL) and hypoalbuminemia (<3.5 g/dL). Preoperative, intraoperative, and 30-day postoperative outcomes, including complications and readmissions, were compared using the univariate tests and multivariable logistic regression.

Results: We included a total of 7277 cases, among whom 96% (n = 6964) had normal albumin values and 4% (n = 298) had hypoalbuminemia (n = 298). Patients with hypoalbuminemia showed a significantly higher body mass index (37.1 ± 8.1 vs. 33.3 ± 6.3 kg/m², p < 0.001) and were more likely to be Black or African American (49.0 vs. 27.8%, p < 0.001). Comorbidities such as diabetes (14.7 vs. 7.4%, p < 0.001), chronic obstructive pulmonary disease (4.0 vs. 1.0%, p < 0.001), and hypertension (35.2 vs. 26.3%, p = 0.002) were significantly more prevalent in the hypoalbuminemia group. Hypoalbuminemia was associated with a significantly increased risk of complications (13.8 vs. 6.1%, p < 0.001), with higher rates of superficial incisional infections (7.0 vs. 2.6%, p = 0.001) and unplanned readmissions (3.4 vs. 1.4%, p = 0.05). Multivariable analysis confirmed hypoalbuminemia as an independent predictor of postoperative complications (OR 1.96, p = 0.001), medical complications (OR 2.62, p = 0.02), and surgical complications (OR 1.91, p = 0.02).

Conclusion: Hypoalbuminemia significantly raises the risk of 30-day postoperative complications in breast reduction surgery. Preoperative nutritional assessment and optimization are crucial in improving surgical outcomes, particularly in patients with high body mass index and comorbidities.

Keywords: ACS-NSQIP database; Breast reduction surgery; Hypoalbuminemia; Nutritional status; Surgical outcomes.