Effect Of Postoperative Hypoalbuminemia And Supplement Of Human Serum Albumin On The Development Of Wound Complications Following Lumbar Internal Fixation Surgery

Background:Wound complications are one of the important factors affecting the rapid recovery of orthopedic patients.It is generally believed that evaluation and treatment of the risk factors for wound complications is very important to reduce the incidence of postoperative wound complications and promote rapid recovery of patients.Although preoperative hypoalbuminemia is currently considered to be related to the incidence of wound complications after orthopedic surgery,but it's still unclear about the association between postoperative hypoalbuminemia and wound complications after lumbar internal fixation surgery.In addition,there is a widespread use of human serum albumin to correct postoperative hypoalbuminemia at home and abroad,but whether supplementation with human serum albumin can improve postoperative clinical outcomes is still controversial,especially whether it can reduce the risk of postoperative wound complications remains to be further explored.Objective:This study evaluated the association between albumin levels after lumbar internal fixation surgery and wound complications,postoperative hospital length of stay,and readmission,to assess whether postoperative hypoalbuminemia would increase the risk of wound complications,and prolong postoperative hospital length of stay and increase the risk of readmission.Moreover,we identified the correlation between postoperative supplementation of human serum albumin and wound complications,to assess whether postoperative supplementation of human serum albumin can improve postoperative wound healing and reduce the risk of wound infection.The purpose of this study was to explore the effectiveness and rationality of supplement of human serum albumin after spinal lumbar internal fixation surgery.Methods:602 patients who underwent lumbar internal fixation surgery in department of orthopedics between January 2014 and December 2018 were identified.All patients'clinical records were reviewed,including:demographics data,Comorbidity data,preoperative serum laboratory values,intraoperative factor,postoperative serum laboratory values,supplement of HSA,postoperative adverse events and follow-up data,and evaluate the incidence of wound complications such as fat liquefaction,wound dehiscence,and wound infection.The statistical analyses were performed with R software and Empower(R),to analysis of risk factors for postoperative hypoalbuminemia and the association between postoperative hypoalbuminemia and wound complications,postoperative hospital length of stay and readmission,and assess the association of supplement of HSA and wound complications.Results:(1)A total of 483 patients had hypoalbuminemia(72.76%),and there was a statistically significant difference in age,preoperative albumin levels,number of fused segments,and ASA score compared to the patients with normal albumin level(P<0.05),multivariate analysis showed that postoperative hypoalbuminemia was associated with age,preoperative albumin levels,and number of fused segments(P<0.05).(2)There were 24(3.99%)patients with wound infection after surgery,and 51(8.47%)patients with wound healing of grade B.In addition,28 patients(4.65%)were hospitalized again within 30 days.After adjusting for the confounding factors,multiple regression analysis showed that there was no correlation between postoperative hypoalbuminemia and wound infection,wound healing of grade B(P>0.05),whether or not to supplement of HSA after surgery.Compared with patients with postoperative normal albumin levels,postoperative hypoalbuminemia did not prolong postoperative hospital length of stay or increase the risk of readmission after surgery(P>0.05).(3)There were 207(34.39%)patients administrated with HSA after surgery.After adjusting for confounding factors,multiple regression analysis showed there was no correlation between postoperative supplement of HSA and wound healing of grade B(P>0.05).however,there is a correlation between postoperative supplement of HSA and postoperative wound infection(P<0.05).Conclusions:(1)Hypoalbuminemia after lumbar internal fixation surgery is associated with age,preoperative albumin levels and number of fused segments.(2)Postoperative hypoalbuminemia does not increase the risk of wound complications,prolong postoperative hospital length of stay or increase the risk of readmission.(3)Postoperative supplementation of HSA does not improve wound healing,but may increase the risk of postoperative wound infection.