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Goal-directed Perioperative Albumin Substitution may not Reduce Complications after non cardiac surgery
![Goal-directed Perioperative Albumin Substitution may not Reduce Complications after non cardiac surgery Goal-directed Perioperative Albumin Substitution may not Reduce Complications after non cardiac surgery](https://medicaldialogues.in/h-upload/2024/01/15/750x450_230097-surgery-50-1.webp)
The perioperative period poses significant challenges for patients undergoing high-risk surgery, often leading to postoperative complications. Hypoalbuminemia, or low serum albumin levels, is a known risk factor for such complications. To address this, researchers conducted a clinical trial to investigate the efficacy of goal-directed albumin substitution in reducing postoperative complications. Hypoalbuminemia is associated with increased risk of postoperative complications, prompting consideration for albumin substitution during surgery.
A recent study published in the journal Annals Of Surgery by Stefan J and colleagues. This study aimed to determine whether maintaining serum albumin levels above 30 g/L through goal-directed albumin substitution could mitigate these risks in high-risk surgical patients.
A single-center, randomized, controlled trial was conducted on adult patients with ASA physical status classification 3 to 4 or undergoing high-risk surgery.
Patients with serum albumin levels dropping below 30 g/L were randomly assigned to receive goal-directed albumin substitution or standard care. The primary outcome was the incidence of postoperative complications classified as Clavien-Dindo Classification ≥2 in at least one of nine domains until postoperative day 15.
The key findings of the study were:
2509 patients were included, with 600 (23.9%) developing serum albumin concentrations <30 g/L.
Human albumin (60 g) was substituted to 99.7% of patients in the intervention group and to 18.0% in the standard care group.
Complications classified as Clavien-Dindo Classification ≥2 occurred in 84.7% of patients in the intervention group and 87.3% in the standard treatment group. The risk difference was -2.7% (95% CI, -8.3% to 2.9%).
The study concluded that maintaining serum albumin concentration >30 g/L perioperatively cannot be generally recommended in high-risk noncardiac surgery patients. Despite goal-directed albumin substitution, there was no significant reduction in postoperative complications. This suggests that other factors may contribute more significantly to postoperative outcomes in this patient population.
Reference:
Schaller, S. J., Fuest, K., Ulm, B., Schmid, S., Bubb, C. A. B., Eckstein, H.-H., von Eisenhart-Rothe, R., Friess, H., Kirchhoff, C., Luppa, P., Blobner, M., & Jungwirth, B. Goal-directed perioperative albumin substitution versus standard of care to reduce postoperative complications: A randomized clinical trial (SuperAdd trial). Annals of Surgery,2024;279(3):402–409. https://doi.org/10.1097/sla.0000000000006030
Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751