Association of Preoperative Serum Albumin Levels with Postoperative Surgical Complications Among Patients Undergoing Laparotomy

Abstract

Background: Hypoalbuminemia is a well-recognized risk factor for adverse postoperative outcomes, yet its precise impact on surgical complications in patients undergoing laparotomy remains underexplored in regional healthcare settings, creating a critical gap in risk stratification and perioperative care. Objective: This study aimed to determine the association between preoperative serum albumin levels and the incidence of postoperative surgical complications among patients undergoing laparotomy, hypothesizing that hypoalbuminemia increases the risk of adverse outcomes. Methods: A prospective cohort study was conducted at Bolan Medical College and Sandeman Provincial Hospital, Quetta, enrolling 134 adult patients scheduled for laparotomy and meeting defined inclusion/exclusion criteria. Patients were categorized by preoperative serum albumin status (hypoalbuminemia <3.4 g/dL vs. normal ≥3.5 g/dL). Baseline demographic and clinical data were collected, and postoperative complications were monitored for 30 days through physical examination and imaging. The study received institutional ethical approval in compliance with the Declaration of Helsinki. Statistical analyses, including Chi-square tests and risk estimations, were performed using SPSS version 27.0. Results: Postoperative complications occurred in 49.3% of hypoalbuminemic patients versus 10.4% of those with normal albumin (p < 0.001), with significant increases observed in surgical site infection (31.3% vs. 4.5%), anastomotic leak (22.4% vs. 3%), gastrointestinal fistula (10.4% vs. 1.5%), and prolonged ileus (19.4% vs. 1.5%). Conclusion: Preoperative hypoalbuminemia is strongly associated with an increased risk of postoperative complications in laparotomy patients, supporting the integration of serum albumin assessment and nutritional optimization into surgical care pathways to improve outcomes and patient safety.