(1254) Preoperative Hypoalbuminemia Predicts Adverse Outcomes Following Functional Endoscopic Sinus Surgery

Introduction: Functional endoscopic sinus surgery (FESS) is commonly performed in patients with significant comorbidities, yet nutritional assessment is not routinely incorporated into preoperative risk stratification. Hypoalbuminemia is an established marker of poor nutritional status and a predictor of morbidity in multiple surgical populations. Evaluating the impact of preoperative hypoalbuminemia on complication rates following FESS may identify a modifiable risk factor to improve outcomes and safety.

Methods: Retrospective cohort study using the TriNetX database to identify adults undergoing FESS. Patients were grouped by albumin level into low ( < 3.5 g/dL; n = 2308) and normal (≥3.5 g/dL; n = 9161) cohorts. Propensity score matching for cardiovascular, metabolic, and other comorbidities produced two cohorts (n = 2233 each). Thirty-day healthcare utilization, reoperation, and postoperative complications were compared using odds ratios with 95% confidence intervals.

Results: Following propensity score matching, preoperative hypoalbuminemia was associated with greater risk for emergency department visit (OR = 1.42, 95% CI [1.13, 1.78]), hospital readmission (OR = 2.35, 95% CI [1.87, 2.95]), and blood transfusion (OR = 2.12, 95% CI [1.64, 2.73]). 30-day reoperation rates were higher in patients with hypoalbuminemia (OR = 2.34, 95% CI [1.75, 3.13]). Patients with hypoalbuminemia also faced increased risk of pneumonia (OR = 1.88, 95% CI [1.15, 3.07]), acute kidney failure (OR = 2.99, 95% CI [1.88, 4.74], venous thromboembolism (OR = 3.53, 95% CI [1.80, 6.92]), and sepsis (OR = 3.93, 95% CI [2.27, 6.82]. No significant difference in epistaxis requiring intervention was observed (1.7 vs 1.7%, OR = 1.00, 95% CI [0.63, 1.58]).

Conclusions: Preoperative hypoalbuminemia independently predicts adverse postoperative FESS outcomes. Patients with low albumin experienced increased 30-day healthcare utilization and higher rates of medical complications. These results support the value of albumin optimization as part of preoperative risk reduction strategies, particularly in high-risk patients.