aDepartment of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, ChinabDepartment of Anesthesiology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, ChinacDepartment of Critical Care Medicine, Peking University Third Hospital, Beijing, ChinadDepartment of Biostatistics, Peking University First Hospital, Beijing, China
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Purpose:To explore the association between the severity of preoperative hypoalbuminemia and the occurrence of postoperative delirium.Materials and methods:This was a secondary analysis of the database from a previously conducted clinical trial. 700 elderly patients (age ≥65 years) who were admitted to intensive care unit (ICU) after noncardiac surgery were included. Delirium was assessed with the Confusion Assessment Method for the ICU twice daily during the first 7 days postoperatively. Other outcomes were also monitored. The relationship between preoperative albumin level and postoperative delirium were analyzed using a logistic regression model.Results:111 of 700 patients (15.9%) developed postoperative delirium. When compared with normal albumin level (>40.0 g/L), severe (≤30.0 g/L: OR 2.727, 95% CI 1.283–5.797, P = 0.009), but not mild (35.1–40.0 g/L: OR 1.175, 95% CI 0.679–2.032, P = 0.565) or moderate (30.1–35.0 g/L: OR 1.674, 95% CI 0.897–3.122, P = 0.105) hypoalbuminemia was associated with an increased risk of postoperative delirium. Preoperative severe hypoalbuminemia was also associated with prolonged mechanical ventilation, increased non-delirium complications, and prolonged ICU and hospital stay after surgery.Conclusions:Preoperative severe hypoalbuminemia (≤30.0 g/L) was associated with an increased risk of postoperative delirium and worse outcomes.Trial registration:Chinese Clinical Trial Registry, www.chictr.org.cn, ChiCTR-TRC-10000802.HighlightsDelirium is a common complication in elderly patients after surgery.Preoperative severe hypoalbuminemia (defined as serum albumin ≤30.0 g/L) is independently associated with an increased risk of developing postoperative delirium; it is also associated with other worse outcomes after surgery.Whether prophylactic correction of preoperative severe hypoalbuminemia can improve postoperative outcomes of elderly patients is still unknown.