Preoperative and early postoperative albumin thresholds, rather than ΔAlb, predict severe complications after colorectal cancer surgery: a multifactorial model and nomogram

Development of the Novel G-CMAP Score: A Preoperative Scoring System for Predicting Postoperative Complications After Gastrectomy for Gastric Cancer.

Postoperative day 3 geriatric nutritional risk index as an early warning marker for anastomotic leakage after colorectal cancer surgery: A retrospective cohort study

Anastomotic leakage (AL) is a serious complication after colorectal cancer (CRC) surgery, and early postoperative risk stratification remains clinically challenging. The Geriatric Nutritional Risk Index (GNRI) integrates serum albumin and body weight information, but its role as a postoperative marker and its incremental value beyond albumin alone remain uncertain. This single-center retrospective cohort study included 302 patients who underwent laparoscopic radical colorectal cancer surgery at Yanbian University Hospital between January 2022 and October 2024. Postoperative day 3 (POD3) GNRI and POD3 albumin were evaluated using receiver operating characteristic analysis, paired DeLong testing, correlation and variance inflation factor assessment, exploratory multivariable logistic models, model comparison, 1000-resample bootstrap internal validation, and colon versus rectum subgroup and interaction analyses. AL occurred in 16/302 patients (5.30%). POD3 albumin had a numerically higher area under the receiver operating characteristic curve (AUC) than POD3 GNRI (AUC: 0.744, 95% confidence interval [CI]: 0.617–0.870 vs AUC: 0.691, 95% CI: 0.597–0.785; DeLong P = .331). POD3 GNRI and POD3 albumin were correlated (Pearson R = 0.774; Spearman ρ = 0.761). The apparent AUCs were 0.766 for the clinical model, 0.793 for clinical plus POD3 albumin, and 0.801 for clinical plus POD3 GNRI; corresponding optimism-corrected AUCs were 0.680, 0.706, and 0.724. Bootstrap warnings about fitted probabilities approaching 0 or 1 indicated model instability. Low POD3 GNRI was associated with increased AL risk and may help identify patients for postoperative risk enrichment and heightened surveillance. However, POD3 GNRI should not be interpreted as having established added value beyond albumin alone, and its incremental value remains uncertain. These exploratory findings require external validation.

Predictive value of perioperative D-dimer to albumin ratio for postoperative serious medical complications and one-year mortality in elderly patients with hip fracture: a retrospective study.

BACKGROUND Elderly patients carry high risks of postoperative serious medical complications (PSMC) and mortality, but reliable perioperative predictive indicators remain limited. OBJECTIVE To evaluate the predictive value of perioperative hematological markers for PSMC and 1-year mortality in elderly surgical patients. METHODS A total of 590 patients aged 65-85 years were enrolled. Perioperative blood parameters were measured preoperatively and on postoperative days 1, 3, 5, 7. Patients were grouped by PSMC occurrence and 1-year survival status. ROC analysis was used to assess diagnostic performance. RESULTS PSMC occurred in 58 patients (9.8%), and 89 patients (15.08%) died within 1 year. Perioperative red blood cells, hemoglobin, albumin, creatinine, procalcitonin, troponin, D-dimer, and D-dimer to albumin ratio (DAR) showed significant dynamic changes (all p < 0.01). The PSMC group had lower albumin and higher D-dimer and DAR than the non-PSMC group (all p < 0.01), with markedly higher 1-year mortality (86.21% vs. 7.33%, p < 0.001). Preoperative DAR showed the comparable predictive power for PSMC (AUC = 0.82), followed by D-dimer (AUC = 0.80) and albumin (AUC = 0.69). For 1-year mortality, D-dimer and DAR both had an AUC of 0.74, with DAR exhibiting higher sensitivity (85.39%). Elevated DAR was significantly associated with increased PSMC and mortality risks (both p < 0.001). Multivariate logistic regression showed high DAR was an independent risk factor for PSMC (OR = 26.82, p < 0.001) and 1-year mortality (OR = 21.75, p < 0.001). CONCLUSION Perioperative DAR is a promising prognostic biomarker for PSMC and 1-year mortality in elderly surgical patients. High DAR indicates poor prognosis and may help identify high-risk individuals for targeted intervention.

Early risk stratification of postoperative pneumonia after brain tumor surgery using routine perioperative variables: development and prospective multicenter validation of an interpretable prediction model

This interpretable 11-variable model enables early POP risk stratification after brain tumor surgery and may support timely preventive intervention in neurosurgical care.

Prognostic Nutritional Index and Postoperative Complications After Colorectal Surgery: A Retrospective Cohort Study

Background: The prognostic nutritional index (PNI) is an inexpensive marker derived from serum albumin and peripheral lymphocyte count. Although low PNI has been associated with adverse surgical outcomes, its incremental value beyond basic clinical variables and the stability of commonly used thresholds remain uncertain in heterogeneous colorectal surgical populations. We evaluated the association between preoperative PNI and postoperative complications and examined whether adding PNI improved a basic clinical model. Methods: This retrospective single-center cohort included 205 consecutive adults undergoing colorectal surgery between January 2024 and March 2026. PNI was calculated as albumin (g/L) + 5 × lymphocyte count (109/L). PNI was modeled primarily as a continuous predictor; PNI < 45 was examined secondarily. ROC analysis, multivariable logistic regression, nested-model comparison, calibration assessment, bootstrap internal validation, complete-case sensitivity analysis, and exploratory subgroup analyses were performed. Results: Fifty-six patients (27.3%) had PNI < 45. Postoperative complications occurred in 67 patients (32.7%) overall and were more frequent with PNI < 45 (51.8% vs. 25.5%; RR 2.03, 95% CI 1.40–2.95; OR 3.14, 95% CI 1.65–5.95; Fisher p < 0.001). PNI alone showed modest discrimination (AUC 0.659); the Youden cutoff was 45.45 (sensitivity 50.7%, specificity 78.3%). In the complete-case multivariable model (n = 191), each 5-point decrease in PNI was associated with higher odds of complications (OR 1.52, 95% CI 1.22–1.90; p < 0.001). Adding continuous PNI to age, BMI, and operative approach increased AUC from 0.663 to 0.711 and improved model fit (likelihood-ratio χ2 = 15.89, p < 0.001). Bootstrap resampling showed substantial cutoff variability (95% percentile interval 32.05–52.00). Conclusions: Lower preoperative PNI was associated with postoperative complications and added discriminatory information to a basic clinical model. However, its stand-alone discrimination was modest, the data-derived cutoff was unstable on bootstrap resampling, and residual confounding and clinical heterogeneity limit causal or treatment-directed interpretation. PNI should therefore be considered a risk marker rather than a stand-alone decision rule. Prospective interventional studies in well-defined patient groups are needed to determine whether PNI-guided nutritional optimization improves outcomes.

Preoperative serum albumin levels as predictors of postoperative morbidity in pediatric congenital heart surgery: a retrospective cohort study

Background: Severe congenital heart disease often requires cardiopulmonary bypass (CPB) surgery. Preoperative hypoalbuminemia may adversely affect postoperative recovery; however, the dose–response relationship between preoperative serum albumin levels and early postoperative adverse events remains unclear. Methods: This retrospective cohort study included 1033 pediatric patients with congenital heart disease who underwent CPB surgery between 2018 and 2024. The primary exposure was the preoperative serum albumin level. The primary outcome was early postoperative adverse events, defined as a composite endpoint including mortality, reintubation, prolonged mechanical ventilation, and extended hospitalization. Patients without these events were classified as the non-adverse outcome group. Multivariable logistic regression models were used to evaluate the association between preoperative albumin levels and postoperative outcomes. Restricted cubic spline (RCS) analysis was performed to assess potential nonlinear relationships. Subgroup analyses based on relevant baseline characteristics were considered exploratory and hypothesis-generating. Results: In the fully adjusted model, compared with the lowest quartile, the second and fourth quartiles of preoperative albumin were associated with significantly lower risks of adverse postoperative outcomes, with odds ratios (ORs) of 0.542 (95% CI: 0.328–0.889) and 0.466 (95% CI: 0.268–0.795), respectively. RCS analysis demonstrated a gradual reduction in adverse outcome risk with increasing albumin levels, with the protective effect plateauing at approximately 40.65 g/L. When albumin levels were ≤40.65 g/L, each incremental increase was associated with a significantly reduced risk of adverse outcomes (OR = 0.864; 95% CI: 0.755–0.983; P = 0.030). Above this threshold, the association was no longer statistically significant (OR = 0.997; 95% CI: 0.885–1.120; P = 0.965). Conclusions: Preoperative serum albumin levels were nonlinearly associated with early postoperative adverse outcomes in pediatric patients undergoing congenital heart surgery. Higher albumin levels within the lower-to-mid physiological range were associated with improved postoperative outcomes, whereas further increases provided no additional apparent benefit. These findings are exploratory and require confirmation in prospective multicenter studies.