eP457 - Preoperative Albumin in Crohns: Is Four the New Normal?

Sunday, June 2, 2024

3:54 PM – 3:59 PM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Andrew-Paul Deeb, MD, MSc

Colon & Rectal Surgery Fellow
AdventHealth Colorectal Surgery
Orlando, FL, United States

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This individual has no financial relationships with ineligible companies.

Author(s)

Ashley Althoff, DO

Colorectal Surgery Fellow
AdventHealth
orlando, FL, United States

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LB

Lindsey Bridges, DO

Colorectal Surgery Fellow
Advent Health
AdventHealth
Orlando, FL, United States

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This individual has no financial relationships with ineligible companies.
Meagan Derbyshire, MD (she/her/hers)

Colorectal Surgery Fellow
Advent Health Orlando
Winter Park, FL, United States

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KS

Katherine Specht, DO, MS

Colorectal Surgery Fellow
AdventHealth
Orlando, FL, United States

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Yaniv Zager, MD

Fellow
Adventhealth
Althamone Springs, FL, United States

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Christopher T. Aquina, MD, MPH

Assistant Professor
AdventHealth Orlando
Orlando, FL, United States

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Senior Author(s)

John RT Monson, MD

Professor of Surgery
Northwell Health
Northwell Health
Ridgefield, CT, United States

Disclosure information not submitted.

Purpose/Background: Most patients with Crohns disease will require surgical intervention during their lifespan despite marked improvements in multidisciplinary strategies. Patients failing medical management often present malnourished, with heightened operative risk. Additionally, common risk factors include tobacco use and corticosteroid administration. We sought to identify a threshold albumin to target for select patients who can safely afford directed operative delay for the purpose of nutritional pre-habilitation.Methods/Interventions: The American College of Surgeon’s National Quality Improvement Program (2005-2021) database was queried for patients undergoing resection for Crohns disease. Preoperative albumin was analyzed to identify the optimal level associated with improved outcomes as well as to evaluate the standard threshold of 3.5 g/dL compared to higher and lower cut-offs. Primary endpoints of 30-day major and infectious complications, and length of stay were evaluated using multivariable regression modeling adjusting for patient characteristics and comorbidities including corticosteroid use and smoking.Results/Outcomes: A total of 15,787 patients were identified, of which 13,110 (83%) underwent elective resection. More than 22% were current smokers, and 58% were on corticosteroids. After risk-adjustment, patients with hypoalbuminemia < 4.0 g/dL experienced a 2-fold increase in the odds of postoperative infectious (OR 2.2; 95%CI 1.9-2.5) and major complications (OR 1.9; 95%CI 1.7-2.3). This risk increased with worsening severity of hypoalbuminemia. Notably, albumin >4 g/dL was protective from postoperative morbidity (OR 0.65; 95%CI 0.58-0.73). Subset analysis excluding emergent cases corroborated these findings. Hypoalbuminemia was also associated with increased hospital length of stay (+3.3 days ±0.1; p < 0.01).Conclusion/

Discussion: When clinically feasible, one should consider routine preoperative nutritional optimization, potentially with parenteral nutrition, with a minimum target albumin of 4, as opposed to the published normal of 3.5. This time interval might also provide a window for smoking cessation and corticosteroid weaning which may further improve outcomes.