Preoperative serum albumin as a predictor of postoperative morbidity and mortality in major gastrointestinal surgery: A retrospective study

Preoperative hypoalbuminemia has been associated with adverse surgical outcomes and may serve as a predictor of postoperative morbidity and mortality in patients undergoing gastrointestinal surgery. This retrospective observational study was conducted at Nepal Mediciti Hospital from January 2023 to December 2025 and included 122 patients undergoing major gastrointestinal surgical procedures. Patients were categorized into two groups based on preoperative serum albumin levels: hypoalbuminemia (<3.5 g/dL) and normal serum albumin (≥3.5 g/dL). The mean age of the study population was 60.71 ± 14.89 years, and 56.6% were male. Fifty-six patients had hypoalbuminemia, while 66 had normal serum albumin levels. Overall postoperative complications occurred in 38 patients (31.15%). Patients with hypoalbuminemia had a significantly higher rate of postoperative complications compared with those with normal serum albumin levels (46.43% vs. 18.18%; p=0.0009). Surgical site infection was the most common complication, followed by anastomotic leak and delayed gastric emptying. Postoperative pneumonia occurred exclusively in the hypoalbuminemia group (p=0.0418). The overall mortality rate was 8.20%, with significantly higher mortality in patients with hypoalbuminemia than in those with normal serum albumin levels (14.29% vs. 3.03%; p=0.0426). These findings demonstrate that preoperative hypoalbuminemia is significantly associated with increased postoperative morbidity and mortality following major gastrointestinal surgery and may serve as a reliable predictor of adverse postoperative outcomes.