The Role of Serum Protein, Haemoglobin, and BMI as Predictors of Postoperative Morbidity and Mortality in Major Surgeries

Background: Pre-operative nutritional assessment is necessary for all patients undergoing surgery in order to prevent post-operative complications. This is because wound healing is an anabolic process requiring adequate protein stores in our body. Serum albumin levels has been found to be a reliable tool in assessing the nutrition when used along with two other parameters namely, haemoglobin and body mass index. It is necessary to provide adequate nutritional support prior surgery for better clinical outcome post-operatively.

Objectives: To assess role of pre-operative serum albumin, haemoglobin and BMI as predictors of post-operative morbidity and mortality in major open surgeries.

Materials and Methods:Sixty patients more than 18 years of age posted for elective and emergency laparotomy in the general surgery ward were included in this study based upon the inclusion and exclusion criteria. Detailed history, clinical examination, anthropometry and nutritional assessment with pre-operative serum albumin, haemoglobin and BMI were done. Post-surgery the details of the procedure, anaesthesia, duration of surgery, duration of hospital stay and early post-operative complications were studied. The patients were followed up till they got discharged from the hospital. The data obtained was analysed.

Results: Maximum number of post-operative complications were in the age group of 40-59 years (36.66%). Seroma followed by surgical site infections were the two most common complications seen among the study population. Most of the complications were seen among patients with serum albumin <3.5gm/dl. Patients with hypoalbuminemia and anaemia had a tendency to develop more post-operative complications and this was found to be statistically significant. (p value <0.05) There was no significant relationship between abnormal BMI and complications in the present study.

Conclusion: Pre-operative hypoalbuminemia <3.5gm/dl and anaemia were found to be independent risk factors for post-operative morbidity and mortality in major open surgeries. Although the relationship between BMI and complications was not found to be statistically significant, it is also essential to stabilise BMI prior to surgery for better clinical outcome.