Impact of Hypoalbuminemia on Morbidity and Mortality After Radical Cystectomy

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.