Pre-Operative Serum Albumin as a Predictor of Post Operative Outcome in Emergency Bowel Anastomosis: An Observational Study in Victoria Hospital, Bengaluru

Abstract

Introduction: Hypoalbuminemia is associated with increased postoperative morbidity and mortality in patients undergoing major abdominal surgery. Emergency bowel anastomosis, performed in a physiologically stressed and often catabolic patient, carries a particularly high risk of anastomotic leak and other complications, and preoperative nutritional status may influence these outcomes.

Aim: To evaluate preoperative serum albumin as a predictor of postoperative outcome in patients undergoing emergency bowel anastomosis.

Materials and Methods: This hospital-based prospective observational study was conducted in the Department of General Surgery, Victoria Hospital, Bengaluru, over a 6-month period (January–June 2026). A total of 100 patients undergoing emergency bowel anastomosis were included. Preoperative serum albumin was measured and patients were categorised as having normal (≥3.5 g/dl) or low (<3.5 g/dl) albumin. Preoperative clinical presentation and postoperative outcomes — including surgical site infection, pulmonary complications, ventilatory support, sepsis, prolonged ileus, anastomotic leak, cardiac complications, prolonged hospitalisation, and mortality — were recorded and analysed against albumin category.

Results: Of 100 patients, 42 had normal and 58 had low preoperative serum albumin. Mean serum albumin was significantly lower in patients who developed fever, surgical site infection, pulmonary complications, need for ventilatory support, sepsis, cardiac complications, prolonged hospitalisation, and mortality (all p<0.001–0.001), and low albumin (categorically) was significantly associated with the same outcomes as well as vomiting (p=0.005) and anastomotic leak (p<0.001). Pain abdomen, per-abdominal tenderness, and prolonged ileus were not significantly associated with albumin level.

Conclusion: Preoperative serum albumin is a simple, inexpensive, and clinically useful marker for predicting postoperative morbidity — including anastomotic leak — and mortality in patients undergoing emergency bowel anastomosis. Routine preoperative assessment may help identify high-risk patients for closer perioperative monitoring and nutritional optimisation.