An algorithm based on the postoperative decrease of albumin (ΔAlb) to anticipate complications after liver surgery

Background Perioperative decrease of albumin (Delta Alb) appeared as a promising predictor of complications after digestive surgery, but its role after liver surgery remains unclear. This study aimed to analyze whether and how Delta Alb can be used to predict complications after liver surgery. Methods A bicentric retrospective analysis of patients undergoing liver surgery (2010-2016) was performed, following TRIPOD guidelines. The preoperative and postoperative difference of albumin was calculated on POD 0 and defined as Delta Alb. Patients with any missing variable were excluded. The primary endpoint was overall complications according to the Clavien classification. A multiparametric algorithm based on Delta Alb was generated to optimize prediction performance. Results A total of 110 patients were analyzed. At least one complication occurred in 66 (60%) patients. Patients with and without complication showed a Delta Alb of 15.8 vs. 9.5 g/L (p<0.001). Area under ROC curve (AUC) of Delta Alb was 0.75 (p<0.01.). The Delta Alb-based algorithm showed an AUC of 0.84 (p<0.01), significantly improving performance (p=0.03). Multivariable analysis identified Delta Alb as independent predictor of complications (HR, 1.12; 95% CI, 1.01-1.07; p = 0.002). Conclusions Delta Alb appeared as a promising predictor independently associated with the risk of complication after liver surgery. The study presents a novel decision-tree based on Delta Alb to anticipate complications.

Automated summary

Delta Alb appears to be a promising predictor independently associated with the risk of complications after liver surgery. The study presents a novel decision-tree based on Delta Alb to anticipate complications.