Low protein, high risk: hypoalbuminemia predicts adverse outcomes after mastectomy in 37,848 breast cancer patients.
Schaschinger Thomas T, Niederegger Tobias T, Diatta Fortunay F, Matar Dany Y DY et al.
Hypoalbuminemia is a well-known marker of poor nutritional status and has been linked to adverse outcomes in various surgical specialties. However, its role in mastectomy remains underexplored. This study investigates the impact of hypoalbuminemia on 30-day postoperative outcomes in patients undergoing mastectomy for breast cancer. Using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2021, we identified 37,848 female breast cancer patients who underwent mastectomy without concurrent reconstructive procedures and had documented preoperative serum albumin levels measured within 30 days of surgery. Patients were stratified by albumin level (< 3.5 g/dL vs. ≥3.5 g/dL). Multivariate logistic regression was used to assess the association between hypoalbuminemia and postoperative 30-day outcomes. ROC analysis identified albumin thresholds predictive of complications. Among 37,848 patients, 3,210 (8.5%) were hypoalbuminemic. Hypoalbuminemia was significantly associated with higher rates of any complication (16% vs. 10%; OR 1.4, p < 0.001), surgical complications (10% vs. 5.5%; OR 1.5, p < 0.001), medical complications (0.37% vs. 0.13%; OR 1.8, p < 0.001). Similarly, readmissions were significantly more frequent in hypoalbuminemic patients (7.0% vs. 3.9%; OR 1.6, p < 0.001). The need for transfusion was over three times higher (5.0% vs. 1.4%, p < 0.001), and hypoalbuminemia was associated with longer hospital stays (2.2 vs. 1.3 days, p < 0.001). Subgroup analysis revealed that these trends persisted across both total and radical mastectomy procedures. Optimal albumin thresholds for predicting complications ranged from 3.7 to 4.1 g/dL, depending on the type of complication. Preoperative hypoalbuminemia is an independent predictor of increased postoperative morbidity following mastectomy. Clinicians may consider selective albumin assessment as a pragmatic tool for identifying patients with increased physiological vulnerability who may benefit from targeted preoperative optimization strategies, rather than as a stand-alone indicator of nutritional deficiency; however, further research is needed to establish optimal testing strategies and confirm clinical benefits.