# Impact of Hypoalbuminemia on Morbidity and Mortality After Radical Cystectomy

## TL;DR

Low blood albumin before bladder cancer surgery increases risks of complications and death, suggesting pre-surgery nutritional improvement could help patients recover better.

## Contribution

This study shows that preoperative hypoalbuminemia independently predicts worse outcomes after radical cystectomy, emphasizing its role in preoperative optimization.

## Key findings

- Patients with preoperative albumin <3.0 g/dL had significantly higher rates of infections, reoperations, and mortality.
- Albumin <3.5 g/dL was independently associated with increased morbidity and mortality after radical cystectomy.
- Nutritional optimization targeting albumin levels could improve surgical outcomes in bladder cancer patients.

## Abstract

Radical cystectomy is a major surgery for bladder cancer, but it carries high risks of complications and death. Poor nutrition before surgery can worsen these risks. Serum albumin, a simple blood test, reflects the nutritional status and may predict outcomes. In this study, we analyzed thousands of patients to see how albumin levels relate to infections, reoperations, the hospital stay, and survival. We found that even small drops in albumin significantly increase complications and mortality. Because albumin is easy to measure and can be improved before surgery, these findings highlight the importance of nutritional optimization. This research may guide surgeons and care teams to include albumin-based screening and prehabilitation in treatment plans, improving recovery and reducing risks for patients undergoing bladder cancer surgery.

Objective: To evaluate the role of serum albumin in predicting surgical outcomes after radical cystectomy. Methods: Retrospective cohort analysis of adults who underwent radical cystectomy from 2019 to 2022 within the ACS NSQIP dataset. Patients were stratified into three groups based on preoperative serum albumin: <3.0 g/dL, 3.0–3.5 g/dL, and >3.5 g/dL. Primary outcomes were surgical site infections, wound disruption, reoperation rates, prolonged hospitalization, and 30-day mortality. Regression analyses assessed the impact of hypoalbuminemia (<3.5 g/dL) on outcomes. Results: In total, 6748 patients were included in the analysis. Distribution of preoperative albumin levels included 4.8% with albumin less than 3.0 gm/dL (Cohort A), 10.7% with albumin between 3.0 and 3.5 gm/dL (Cohort B), and 84.4% with albumin > 3.5 gm/dL (Cohort C). The incidence of superficial SSI (7.7%), deep SSI (2.2%), wound disruption (4.0%), unplanned reoperation (8.6%), and still in hospital at 30 days (5.5%) was significantly higher in Cohort A (p for all < 0.05). Moreover, 30-day mortality was significantly higher in Cohorts A and B, as compared to Cohort C (2.2% vs. 2.3% vs. 1.3%, p = 0.03). On multivariate logistic regression, albumin < 3.5 gm/dL was significantly associated with reoperation (OR = 1.39, p = 0.031), prolonged hospitalization (OR = 1.28, p = 0.038), and 30-day mortality (OR = 1.74, p = 0.025). Conclusions: Preoperative hypoalbuminemia is independently associated with increased morbidity and mortality following radical cystectomy. Given its modifiable nature, serum albumin should be considered a key target for preoperative optimization.