The perioperative period poses significant challenges for patients undergoing high-risk surgery, often leading to postoperative complications. Hypoalbuminemia, or low serum albumin levels, is a known risk factor for such complications. To address this, researchers conducted a clinical trial to investigate the efficacy of goal-directed albumin substitution in reducing postoperative complications. Hypoalbuminemia is associated with increased risk of postoperative complications, prompting consideration for albumin substitution during surgery.
A recent study published in the journal Annals Of Surgery by Stefan J and colleagues. This study aimed to determine whether maintaining serum albumin levels above 30 g/L through goal-directed albumin substitution could mitigate these risks in high-risk surgical patients.
A single-center, randomized, controlled trial was conducted on adult patients with ASA physical status classification 3 to 4 or undergoing high-risk surgery.

Patients with serum albumin levels dropping below 30 g/L were randomly assigned to receive goal-directed albumin substitution or standard care. The primary outcome was the incidence of postoperative complications classified as Clavien-Dindo Classification ≥2 in at least one of nine domains until postoperative day 15.
The key findings of the study were:
2509 patients were included, with 600 (23.9%) developing serum albumin concentrations <30 g/L.
Human albumin (60 g) was substituted to 99.7% of patients in the intervention group and to 18.0% in the standard care group.
Complications classified as Clavien-Dindo Classification ≥2 occurred in 84.7% of patients in the intervention group and 87.3% in the standard treatment group. The risk difference was -2.7% (95% CI, -8.3% to 2.9%).
The study concluded that maintaining serum albumin concentration >30 g/L perioperatively cannot be generally recommended in high-risk noncardiac surgery patients. Despite goal-directed albumin substitution, there was no significant reduction in postoperative complications. This suggests that other factors may contribute more significantly to postoperative outcomes in this patient population.
Reference:
Schaller, S. J., Fuest, K., Ulm, B., Schmid, S., Bubb, C. A. B., Eckstein, H.-H., von Eisenhart-Rothe, R., Friess, H., Kirchhoff, C., Luppa, P., Blobner, M., & Jungwirth, B. Goal-directed perioperative albumin substitution versus standard of care to reduce postoperative complications: A randomized clinical trial (SuperAdd trial). Annals of Surgery,2024;279(3):402–409. https://doi.org/10.1097/sla.0000000000006030