医学
低蛋白血症
围手术期
随机对照试验
白蛋白
外科
血清白蛋白
临床试验
麻醉
内科学
作者
Stefan Schaller,Kristina Fuest,Bernhard Ulm,Sebastian Schmid,Catherina Bubb,Hans‐Henning Eckstein,Rüdiger von Eisenhart‐Rothe,Helmut Frieß,Chlodwig Kirchhoff,Peter B. Luppa,Manfred Blobner,Bettina Jungwirth
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2023-07-21
卷期号:279 (3): 402-409
被引量:1
标识
DOI:10.1097/sla.0000000000006030
摘要
Objective: To investigate whether goal-directed albumin substitution during surgery and postanesthesia care to maintain a serum albumin concentration >30 g/L can reduce postoperative complications. Background: Hypoalbuminemia is associated with numerous postoperative complications. Since albumin has important physiological functions, substitution of patients with hypoalbuminemia is worth considering. Methods: We conducted a single-center, randomized, controlled, outcome assessor–blinded clinical trial in adult patients, American Society of Anesthesiologists physical status classification 3 to 4 or undergoing high-risk surgery. Patients, whose serum albumin concentration dropped <30 g/L were randomly assigned to goal-directed albumin substitution maintaining serum concentration >30 g/L or to standard care until discharge from the postanesthesia intermediate care unit. Standard of care allowed albumin substitution in hemodynamic instable patients with serum concentration <20 g/L, only. Primary outcome was the incidence of postoperative complications ≥2 according to the Clavien-Dindo Classification in at least 1 of 9 domains (pulmonary, infectious, cardiovascular, neurological, renal, gastrointestinal, wound, pain, and hematological) until postoperative day 15. Results: Of 2509 included patients, 600 (23.9%) developed serum albumin concentrations <30 g/L. Human albumin 60 g (40–80 g) was substituted to 299 (99.7%) patients in the intervention group and to 54 (18.0%) in the standard care group. At least 1 postoperative complication classified as Clavien-Dindo Classification ≥2 occurred in 254 of 300 patients (84.7%) in the intervention group and in 262 of 300 (87.3%) in the standard treatment group (risk difference −2.7%, 95% CI, −8.3% to 2.9%). Conclusion: Maintaining serum albumin concentration of >30 g/L perioperatively cannot generally be recommended in high-risk noncardiac surgery patients.
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