Preoperative severe hypoalbuminemia is associated with an increased risk of postoperative delirium in elderly patients: Results of a secondary analysis

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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,, 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.

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