Is preoperative hypoalbuminaemia or hypoproteinaemia a reliable marker for anastomotic leakage risk in patients undergoing elective colorectal surgery in an Enhanced Recovery after Surgery (ERAS) program?

Abstract

Abstract Purpose: Preoperative hypoalbuminaemia has traditionally been used as a marker of nutritional status and is considered a significant risk factor for anastomotic leak (AL). Methods: The Westmead Enhanced Recovery After Surgery (WERAS) prospectively collected database, consisting of 361 patients who underwent colorectal surgery with primary anastomosis, was interrogated. Preoperative serum albumin and protein levels (measured within one week of surgery) were plotted on receiver operating characteristic curves (ROC curves) and statistically analysed for cutoff values, sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV). Results: The incidence of AL was 4.4% (16/361). Overall mortality was 1.4% (5/361), 6.3% (1/16) in the AL group, 1.2% (4/345) in the no AL group. The median preoperative albumin and protein level in the AL group were 39g/L and 75g/L, respectively. The median preoperative albumin and protein level in the no AL group were 38g/L and 74g/L, respectively. Mann Whitney U test showed no statistically significant difference in albumin levels (p = 0.4457) nor protein levels (p = 0.6245) in the AL and no AL groups. ROC curves demonstrated that preoperative albumin and protein levels were not good predictors of anastomotic leak. Cutoff values for albumin (38g/L) and protein (75g/L) both had poor PPV for AL (4.8% and 3.8% respectively). Conclusion: Preoperative albumin and protein levels in patients undergoing elective colorectal surgery were not reliable independent risk factors for AL. A limitation of this study was that nearly all patients received immune-nutrition or carbohydrate/protein supplementation in the perioperative period as part of an ERAS program.