Effects of Serum Albumin Level in Lower vs Upper Extremity Surgery: A Hospital-based Retrospective Study
Published: May 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60126.17823
Tushar Kanti Bandyopadhyay, Amita Pathak
1. Associate Professor, Department of General Medicine, Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India.
2. Senior Medical Officer, Department of Emergency, West Bengal Health Service, Kolkata, West Bengal, India.
Correspondence
Tushar Kanti Bandyopadhyay,
728, Madurdah, Hossainpur, Kolkata-700107, West Bengal, India.
E-mail: drtkban011@gmail.com
Introduction: Trauma and major surgery often lead to low serum albumin levels in patients. Several studies have reported depressed serum albumin levels in upper and lower extremity and other major surgeries. Metabolic stress response from major surgical interventions and prolonged immobility is primarily responsible for low serum albumin levels in these patients.
Aim: To investigate the preoperative and postoperative serum albumin levels in patients who underwent extremity surgery and compare the changes in albumin levels between those who underwent upper extremity surgery versus lower extremity surgery.
Materials and Methods: This was a hospital-based retrospective study. The study included 120 patients who presented to the Emergency Department of Surgery and Orthopaedics at Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India due to trauma. The study was conducted from November 30, 2018 to November 30, 2021. All patients underwent either lower or upper extremity surgery (Group 1 and Group 2, respectively) by orthopaedic surgeons and were consecutively selected regardless of their ages. The serum albumin levels at the time of admission and on the third day after surgery were obtained from the hospital patient records. Continuous variables were expressed as mean±standard deviation. The normality test of the numerical variables was done using the Kolmogorov-Smirnov test.
Results: The mean age of the population in the upper extremity surgery group was 38.8 years vs 30.5 years in the lower extremity group. A statistically significant difference in the preoperative and postoperative serum albumin levels was found in both groups (p<0.05). Moreover, the mean difference between preoperative and postoperative serum albumin levels was found to be significantly higher in the lower extremity group (1.52±0.32 g/dL) than in the upper extremity group (0.95±0.39 g/dL) (p<0.05), and the coefficient of correlation between these two groups (r>0.7) indicated a significant difference between albumin levels in the two groups.
Conclusion: This study revealed that both upper and lower extremity surgeries caused hypoalbuminaemia. The study was novel in finding that lower extremity surgery caused more severe hypoalbuminaemia in the patients compared to those who underwent upper extremity surgery. A correlation study was done between the two groups, and it was found to be significant with a p-value of <0.05 and an r-value of >0.7. The reason for this significant difference was the longer duration of lower extremity surgery, requiring more fluid support during the surgery and resulting in increased metabolic stress.
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