Role of Decreased Serum Albumin as an Indicator of Wound Healing in Patients Undergoing Midline Abdominal Surgery

Abstract

Background: Wound healing is a critical determinant of surgical recovery, especially in midline abdominal surgeries, where tissue integrity and immune function are essential. Serum albumin, a key nutritional biomarker, has been linked to surgical outcomes, yet its role as a predictive indicator of wound healing remains underexplored in local clinical settings. Objective: To evaluate the role of decreased preoperative serum albumin as a predictor of delayed wound healing and increased postoperative complications in patients undergoing elective midline abdominal surgery. Methods: This prospective quasi-experimental study was conducted at the Department of Surgery, Combined Military Hospital, Rawalpindi, from September 2022 to April 2023. A total of 65 patients were included based on strict inclusion criteria, including age ≥18 years, elective midline abdominal surgery, and available preoperative albumin levels. Patients were stratified into Group A (≥3.5 g/dL) and Group B (<3.5 g/dL). Exclusion criteria included chronic liver/kidney disease, emergency surgeries, and prior abdominal radiation. Data were collected on demographics, intraoperative findings, and wound healing outcomes. Ethical approval was obtained (Ref: EC/A/293), and the study complied with the Declaration of Helsinki. Statistical analysis was performed using SPSS v27, employing chi-square and ANOVA tests. Results: Group B showed significantly prolonged wound healing time (17 ± 3 vs. 13 ± 3 days; p<0.01), higher rates of wound dehiscence (24.0% vs. 5.0%; p<0.05), and increased surgical site infections (24.0% vs. 7.5%; p<0.05). Intraoperatively, tissue friability and suture difficulty were more common in hypoalbuminemic patients (p<0.05), with a longer operative time (98.1 ± 13.8 vs. 82.3 ± 14.1 min; p=0.01). Conclusion: Decreased serum albumin is a clinically significant predictor of delayed wound healing and intraoperative difficulty in midline abdominal surgeries. Routine preoperative albumin assessment and nutritional optimization may enhance patient outcomes and reduce postoperative complications.