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From Serum to Surgery: The Significance of Albumin in Preoperative Risk Stratification—An Analysis of 200,015 Plastic Surgery Patients

Year: 2026

Type: article

Abstract: BACKGROUND: Plastic and reconstructive surgery (PRS) encompasses a wide range of procedures, and postoperative complications remain a persistent challenge. While preoperative laboratory values (PLVs) are routinely assessed, their predictive value for postoperative outcomes in PRS is unclear. This study evaluates the association between PLVs and postoperative morbidity to enhance risk stratification. METHODS: The ACS-NSQIP database (2008-2022) was analyzed for PRS patients. PLVs included sodium, blood urea nitrogen, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white blood cell count, hematocrit, platelets, partial thromboplastin time, international normalized ratio, and prothrombin time (PT). Multivariate logistic regression identified independent predictors of complications, while decision tree analysis established risk thresholds, validated through cross-validation. RESULTS: were included in this study. Albumin levels emerged as the strongest predictor for the occurrence of any complications. Patients with albumin ≤ 3.3 g/dL had a 36.5% risk for the occurrence of any complication compared to 10.4% in those with higher levels. In the high-risk group, prolonged PT (> 16.2s) further increased risk for the occurrence of any complications. Also, in the lower-risk group (albumin > 3.3 g/dL), prolonged PT (> 13.7 s) were found to significantly influence complication occurrence. Further, multivariate analysis confirmed reduced albumin (OR 0.460) as the strongest independent predictors for any complication occurrence. CONCLUSION: Albumin and PT are key predictors of 30-day postoperative complications in PRS. Preoperative optimization of these values can enhance patient safety and surgical outcomes. Findings support integrating targeted preoperative evaluations into clinical practice. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Source: Aesthetic Plastic Surgery

DOI: 10.1007/s00266-026-05800-8