Goal-directed Perioperative Albumin Substitution Versus Standard of Care to Reduce Postoperative Complications - A Randomized Clinical Trial (SuperAdd Trial)
In this single-center, randomized, controlled clinical trial, researchers investigated the effectiveness of goal-directed albumin substitution in reducing postoperative complications in adult patients with hypoalbuminemia undergoing high-risk surgery. The primary objective was to maintain serum albumin concentration above 30 g/L perioperatively and evaluate its impact on postoperative complications using the Clavien-Dindo Classification (CDC). The trial included 2509 patients, of which 600 (23.9%) developed serum albumin concentrations below 30 g/L. Among them, 299 patients (99.7%) received human albumin in the intervention group, while only 54 patients (18.0%) received it in the standard care group. The results showed that at least one postoperative complication classified as CDC≥2 occurred in 84.7% of patients in the intervention group and 87.3% in the standard treatment group, with a risk difference of -2.7% (95% CI, -8.3% to 2.9%). Therefore, the study did not recommend the routine maintenance of serum albumin concentration >30 g/L in high-risk noncardiac surgery patients.
Perspective:
The SuperAdd Trial sheds light on the role of goal-directed albumin substitution in high-risk noncardiac surgery patients with hypoalbuminemia. The findings indicate that maintaining serum albumin concentration above 30 g/L during the perioperative period may not significantly reduce postoperative complications. Although albumin substitution is worth considering for patients with hypoalbuminemia, this study suggests that a universal approach to maintaining a specific serum albumin level may not be warranted in all cases. Physicians should carefully assess individual patient factors and consider albumin substitution for hemodynamically unstable patients with serum albumin concentration below 20 g/L, as allowed by the standard care. Further research may be needed to explore the potential benefits of goal-directed albumin substitution in specific patient subgroups or surgical contexts.
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Goal-directed Perioperative Albumin Substitution Versus Stan... : Annals of Surgery (lww.com)