Sarcopenia and Perioperative Albumin Dynamics Outperform Preoperative Albumin Alone in Predicting Postoperative Morbidity Following Gastrointestinal Surgery: A Prospective Observational Study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Preoperative risk stratification in gastrointestinal surgery remains challenging. Serum albumin has long been recognized as an indicator of nutritional and inflammatory status and is associated with postoperative morbidity and mortality. However, recent evidence suggests that sarcopenia and perioperative albumin kinetics may provide stronger predictive value than static albumin measurements alone. Aims and Objective: To evaluate the predictive value of preoperative serum albumin, postoperative albumin decline (ΔAlb), and sarcopenia for postoperative morbidity in patients undergoing gastrointestinal surgery. Methods: This prospective observational study included 176 patients undergoing major gastrointestinal surgery. Preoperative serum albumin was measured within 24 hours before surgery. Sarcopenia was assessed using skeletal muscle indices from preoperative imaging CT scan. Postoperative albumin difference (ΔAlb) was calculated as the difference between preoperative and postoperative serum albumin levels on post-operative day 3. Postoperative complications were graded according to the Clavien–Dindo classification. Results: Hypoalbuminemia (<3.5 g/dL) was present in 54% of patients. Surgical site infection occurred more frequently in the hypoalbuminemia group (23.2% vs 7.4%, p=0.004). ROC analysis showed that preoperative albumin predicted postoperative complications with AUC 0.72 and an optimal cutoff value of 3.4 g/dL. Multivariate analysis demonstrated that sarcopenia was the strongest independent predictor of postoperative complications (OR 7.20, 95% CI 2.40–21.3, p<0.001) followed by hypoalbuminemia and comorbidities. Conclusion: Sarcopenia and perioperative albumin decline outperform static preoperative albumin levels in predicting postoperative morbidity. Integrating body composition analysis with biochemical markers may significantly improve surgical risk stratification.
Institution: NIMS University
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W7140861340