Postoperative hypoalbuminemia following surgery related to craniosynostosis

Summary Background An episode of postoperative phenytoin toxicity in a patient undergoing surgery related to craniosynostosis highlighted the presence of hypoalbuminemia. We believe that hypoalbuminemia contributed to the altered pharmacokinetics of phenytoin in this case. Objectives To establish the incidence of postoperative hypoalbuminemia in patients undergoing surgery related to craniosynostosis and to investigate the likely etiology. Methods Data on 114 patients undergoing surgery for craniosynostosis over a 2‐year period at Oxford Children's Hospital, between May 2011 and May 2013, were retrospectively reviewed. Twenty‐two patients were excluded due to incomplete data. This cohort represents the entire population for whom transfusion data had been formally collected at our institution. Preoperative and day 1 postoperative serum albumin levels were collected from the hospital laboratory database. Data regarding blood loss and intra‐operative fluid management were reviewed from the anesthetic database. Linear regression analysis was used to establish the relationship between percentage drop in serum albumin with: (i) milliliters per kilogram (ml·kg−1) volume of albumin‐poor fluids used intra‐operatively and (ii) percentage estimated red cell mass loss. Results All patients experienced a statistically significant drop in serum albumin. The mean difference in albumin was 17.1 g·l−1, 95% CI (16.1–18.0) (P