Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2020; 26(11): 1185-1196
Published online Mar 21, 2020. doi: 10.3748/wjg.v26.i11.1185
Preoperative albumin levels predict prolonged postoperative ileus in gastrointestinal surgery
Wen-Quan Liang, Ke-Cheng Zhang, Hua Li, Jian-Xin Cui, Hong-Qing Xi, Ji-Yang Li, Ai-Zhen Cai, Yu-Hua Liu, Wang Zhang, Lan Zhang, Bo Wei, Lin Chen
Wen-Quan Liang, Ke-Cheng Zhang, Jian-Xin Cui, Hong-Qing Xi, Ji-Yang Li, Ai-Zhen Cai, Wang Zhang, Lan Zhang, Bo Wei, Lin Chen, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Hua Li, Department of Surgical Oncology, Xing Tai People's Hospital, Xingtai 054001, Hebei Province China
Yu-Hua Liu, Institute of Army Hospital Management, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
Author contributions: Chen L, Wei B, Liang WQ, Zhang KC and Cui JX designed the study; Liang WQ, Zhang KC and Li H wrote the manuscript; Xi HQ and Cai AZ contributed to the patient material; Liu YH and Zhang L collected the clinical data; Zhang W and Li JY contributed to data analysis and validation. Liang WQ, Zhang KC, Li H and Liu YH contributed equally to this work.
Supported by the National Nature Science Foundation of China, No. 81672319 and No. 81972790; and Beijing Nova Program, No. Z181100006218011.
Institutional review board statement: The study was approved by the Research Ethics Committee of the Chinese People’s Liberation Army General Hospital.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: All authors have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The manuscript meets the requirements of the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lin Chen, MA, MD, PhD, Chief Doctor, Professor, Department of General Surgery & Institute of General Surgery, Chinese People’s Liberation Army General Hospital, 28 Fuxing Road, Beijing 100853, China.
Received: December 20, 2019
Peer-review started: December 20, 2020
First decision: February 18, 2020
Revised: February 20, 2020
Accepted: February 21, 2020
Article in press: February 21, 2020
Published online: March 21, 2020
Research background

Prolonged postoperative ileus (PPOI) is a prolonged state of “pathological” gastrointestinal (GI) tract dysmotility. PPOI is an essential contributor to increased hospitalization costs and prolonged hospitalization.

Research motivation

It is well known that preoperative albumin affects the outcome and mortality of patients undergoing any surgical procedure. We hypothesized that preoperative albumin may be an independent indicator of PPOI.

Research objectives

The present study aimed to investigate the association between preoperative albumin and PPOI to establish a nomogram for clinical risk evaluation.

Research methods

A total of 311 patients diagnosed with gastric or colorectal cancer were retrospectively included. We performed univariate and multivariable logistic regression analyses to determine the relationship between variables and PPOI, and a nomogram to quantify the presence of PPOI was developed and internally validated.

Research results

The overall PPOI rate was 21.54%. Patients in an advanced tumor stage and who were administered postoperative opioid analgesics were more likely to develop PPOI. This study found and further confirmed that preoperative albumin was an independent predictor of PPOI. A nomogram was established to accurately quantitate the probability of PPOI occurrence. This nomogram was confirmed to have a good diagnostic performance and was also internally validated.

Research conclusions

Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. An easy-to-use nomogram was established to quantify the presence of PPOI, which may serve as an early warning sign of PPOI in clinical practice.

Research perspectives

Due to the retrospective nature of this study, caution should be exercised in proposing the nomogram in clinical practice.