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Increasing serum albumin levels may shorten hospital length of stay after cystectomy

06 Nov 2017

Nutritional optimization before surgery is associated with shorter length of hospital stay following cystectomy, a recent study has found. However, diminishing returns occur for preoperative serum albumin levels above a threshold of 4 gm/dl.

The authors obtained data from the 2014 to 2015 National Surgical Quality Improvement Program database and identified a total of 1,582 adults who underwent cystectomy between 1 January 2014 and 31 December 2015 and had a documented preoperative serum albumin level.

Time to hospital discharge was the primary outcome, and preoperative serum albumin was the primary exposure. A Cox proportional hazards model was created to evaluate associations with adjustment for a set of predefined confounders. Using a restricted cubic spline with three knots, all continuous variables were allowed to have a nonlinear relationship with the primary outcome.

There was an independent association between preoperative serum albumin and hospital length of stay after cystectomy. Increasing preoperative serum albumin below a threshold of 4 gm/dl shortened length of stay (hazards ratio [HR], 1.05; 95 percent CI, 1.01 to 1.09; p<0.004).

Other significant predictors of longer length of stay were as follows: patient age (HR, 0.84; 0.77 to 0.91; p<0.001), non-Caucasian race (HR, 0.81; 0.70 to 0.93; p=0.003) and American College of Surgeons classification 4 (class 4 vs 3 HR, 0.78; 0.62 to 0.97; p=0.008). Furthermore, minimally invasive cystectomy correlated with a shorter length of stay (HR, 1.23; 1.07 to 1.42; p=0.004).

An earlier study found that poor nutritional status measured by serum albumin predicted an increased rate of surgical complications following cystectomy, stressing the importance of preoperative nutritional status and the need for developing effective nutritional interventions in the preoperative setting. [World J Urol 2015;33:1129-37]

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