Login to Access Video or Poster Abstract: MP96-17
Sources of Funding: The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Introduction

Serum albumin levels have been reported to be a valid measure of nutritional status for epidemiologic studies. However, contemporary population-based epidemiologic data evaluating the effect of preoperative albumin levels on LOS after cystectomy and urinary diversion is limited. In this study, we measure the relationship between preoperative serum albumin level and hospital LOS and hypothesized that decreasing preoperative albumin levels would be associated with increasing LOS. Such an association would strengthen the importance of preoperative nutritional optimization prior to cystectomy.

Methods

Data was acquired from the 2014-2015 National Surgical Quality Improvement Program database. We identified 2,469 adult patients who underwent a cystectomy between January 1st 2014 and December 31st 2015. The primary outcome was hospital LOS and the primary exposure was preoperative albumin. We fit proportional odds logistic model with patient-level variables that were either known to be associated with increased LOS or that we had hypothesized would be prior to model fitting. We allowed all continuous variables to have a nonlinear relationship with the primary outcome using restricted cubic spline with 5 knots.

Results

Multivariable proportional odds logistic regression determined that preoperative serum albumin was independently associated with LOS (OR: 0.81; 95% CI: 0.64-1.02; p<0.001). Figure 1 demonstrates that LOS increases significantly for patients with a serum albumin level of less than 4 g/dl. Other significant predictors include older age (OR 1.56; 95% CI 1.21-2.01; p<0.001), elevated BMI (OR 1.48; 95% CI 1.17-1.86; p<0.001), and non-Caucasian patients (OR 1.7; 95% CI 1.34-2.18; p<0.001).

Conclusions

This study provides evidence that lower preoperative serum albumin levels are associated with increasing LOS. Efforts to optimize a patient's nutritional status prior to cystectomy undoubtedly have many benefits, including a shorter LOS.

Funding

The project described was supported by the National Center for Research Resources, Grant UL1 RR024975-01, and is now at the National Center for Advancing Translational Sciences, Grant 2 UL1 TR000445-06. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.