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Results From the National VA Surgical Risk Study

James Gibbs, PhD; William Cull, PhD; William Henderson, PhD; Jennifer Daley, MD; Kwan Hur, MS; Shukri F. Khuri, MD

Arch Surg. 1999;134:36-42.

Objective  To improve the precision and reliability of estimates of the association between preoperative serum albumin concentration and surgical outcomes.

Design  Prospective observational study. Patients were followed up for 30 days postoperatively. Multiple logistic regression models were developed to evaluate serum albumin level as a predictor of operative mortality and morbidity in relation to 61 other preoperative patient risk variables.

Setting  Forty-four tertiary care Veterans Affairs (VA) medical centers.

Patients  A total of 54,215 major noncardiac surgery cases from the National VA Surgical Risk Study.

Main Outcome Measures  Thirty-day operative mortality and morbidity.

Results  A decrease in serum albumin from concentrations greater than 46 g/L to less than 21 g/L was associated with an exponential increase in mortality rates from less than 1% to 29% and in morbidity rates from 10% to 65%. In the regression models, albumin level was the strongest predictor of mortality and morbidity for surgery as a whole and within several subspecialties selected for further analysis. Albumin level was a better predictor of some types of morbidity, particularly sepsis and major infections, than other types.

Conclusions  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, particularly in populations in whom comorbid conditions are relatively frequent.

From the Cooperative Studies Program Coordinating Center, the Edward Hines, Jr, VA Hospital, Hines, Ill (Drs Gibbs, Cull, and Henderson and Mr Hur); Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Ill (Drs Gibbs, Cull, and Henderson); Brockton/West Roxbury VA Medical Center, West Roxbury, Mass (Drs Daley and Khuri); and Harvard Medical School (Drs Daley and Khuri), Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Dr Daley), and Brigham and Women's Hospital (Dr Khuri), Boston, Mass.

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