Risk factors for postoperative hypoalbuminemia in ovarian cancer: a predictive nomogram.

Objective: Postoperative hypoalbuminemia increases the risk of delayed wound healing and infections and prolongs hospital stays, and may even increases mortality. Hypoalbuminemia is commonly observed after radical ovarian cancer surgery. The primary aim of this study is to determine risk factors for postoperative hypoalbuminemia after radical ovarian cancer surgery, and to develop a prediction nomogram for its prevention and management.

Methods: This retrospective study analyzed patients who underwent radical ovarian cancer surgery at Ya'an People's Hospital, Sichuan Province, China, from January 2018 to December 2023. All surgeries were performed by the same surgical team. A total of 142 patients were included for analysis. Patients were divided into two groups based on their serum albumin(ALB) levels on postoperative day 1: the hypoalbuminemia group (ALB < 35 g/L) and the control group (ALB ≥ 35 g/L). Univariate and multivariate analyses were used to identify risk factors, and a prediction nomogram was developed based on the statistical results. The prediction performance of the risk factors and the model was evaluated using receiver operating characteristic (ROC) curves.

Results: Among the 142 patients, 69 developed postoperative hypoalbuminemia, with an incidence rate of 48.6%. Univariate and multivariate binary logistic regression analyses revealed that the independent risk factors for postoperative hypoalbuminemia in ovarian cancer patients included: preoperative C-reactive protein (CRP) level, preoperative ALB level, excessive intraoperative net fluid gain, weight loss > 5% in the month prior to surgery, and concomitant gastrointestinal surgery. The nomogram model, based on these five independent risk factors (Area Under the Curve [AUC] = 0.898, 95% CI: 0.846-0.949, sensitivity: 0.826, specificity: 0.836).

Conclusion: Preoperative CRP level, preoperative ALB level, excessive intraoperative net fluid gain, weight loss > 5% in the month prior to surgery, and concomitant gastrointestinal surgery are independent risk factors for postoperative hypoalbuminemia in patients undergoing radical ovarian cancer surgery. The nomogram prediction model, based on these five factors, can effectively predict the risk of postoperative hypoalbuminemia, offering a guide for managing this complication.