Z Gastroenterol 2025; 63(08): e497
DOI: 10.1055/s-0045-1810860
Abstracts | DGVS/DGAV
Kurzvorträge
Pankreas: Komplikationsrisiko Freitag, 19. September 2025, 16:30 – 17:50, Seminarraum 14 + 15

Preoperative hypoalbuminemia: a hidden predictor of morbidity and mortality after pancreatoduodenectomy

Authors

  • A Ramouz

    1   Universitätsklinikum Heidelberg, Allgemein-, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland

  • A Al-Ahdal

    1   Universitätsklinikum Heidelberg, Allgemein-, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland

  • G Polychronidis

    1   Universitätsklinikum Heidelberg, Allgemein-, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland

  • A Mehrabi

    1   Universitätsklinikum Heidelberg, Allgemein-, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland

  • M Loos

    1   Universitätsklinikum Heidelberg, Allgemein-, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland

  • M W Büchler

    2   Botton-Champalimaud Pancreatic Cancer Centre, Lisbon, Portugal

  • M Al-Saeedi

    1   Universitätsklinikum Heidelberg, Allgemein-, Viszeral und Transplantationschirurgie, Heidelberg, Deutschland
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Background: Pancreatoduodenectomy (PD) is the standard surgical approach for treating benign and malignant pancreatic lesions. Preoperative hyperbilirubinemia has been associated with adverse postoperative outcomes; however, the predictive significance of hypoalbuminemia remains unclear. This study aims to assess the impact of preoperative serum albumin and bilirubin levels on clinical outcomes in patients undergoing PD.

Methods: Patients who underwent partial or total PD at a single high-volume pancreatic surgery center were identified from a prospectively maintained database. Patients were categorized by preoperative serum albumin levels as normal (3.5–5 g/dL), mild hypoalbuminemia (3.0–3.49 g/dL), and moderate/severe hypoalbuminemia (<3.0 g/dL). Preoperative bilirubin levels were classified as mild (<10 mg/dL), moderate (10–15 mg/dL), or severe (>15 mg/dL). Postoperative complications, including pancreatic fistula (POPF), post-pancreatectomy hemorrhage (PPH), and mortality were analyzed across groups.

Results: Among 1149 patients undergoing PD, mild and moderate/severe hypoalbuminemia were observed in 42 and 32 patients, respectively. Moderate and severe hyperbilirubinemia occurred in 64 (5.6%) and 24 (2.1%) patients, respectively. Patients with moderate/severe hypoalbuminemia had significantly higher rates of grade C POPF (p<0.01) and PPH (p<0.01). Mortality rates at 30 and 90 days were 18.8% and 25%, respectively, among these patients, significantly higher than those with normal or mild hypoalbuminemia (p<0.01). Multivariate analysis identified moderate/severe hypoalbuminemia as an independent predictor of 30-day (odds ratio 4.9, p=0.03) and 90-day mortality (odds ratio 9.8, p<0.01).

Conclusion: Moderate/severe preoperative hypoalbuminemia is independently associated with worse outcomes, including increased postoperative complications and higher short-term mortality. These findings highlight the importance of hypoalbuminemia compared to hyperbilirubinemia, and emphasize the role preoperative optimization of nutritional and metabolic status in preventing hazardous events for patients undergoing PD.



Publication History

Article published online:
04 September 2025

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