Association Between Preoperative Serum Albumin and Surgical Site Infection Following Emergency Exploratory Laparotomy: A Retrospective Observational Study

Abstract Introduction: Surgical site infection (SSI) is a major complication after emergency laparotomy. This study evaluated the association between preoperative hypoalbuminaemia and SSI. Methods: This retrospective observational study included 250 adults undergoing emergency exploratory laparotomy at a rural tertiary-care centre between January 2024 and January 2026. Hypoalbuminaemia was defined as serum albumin <3.5 g/dL. The primary outcome was documented SSI. Associations were assessed using contingency-table analysis and multivariable logistic regression. Results: Mean age was 50.5 years; 146 patients (58.4%) were male. Hypoalbuminaemia was present in 139 (55.6%). SSI occurred in 54 patients (21.6%; 95% CI 16.9–27.1). SSI occurred in 44 of 139 patients with hypoalbuminaemia (31.7%) and 10 of 111 with normal albumin (9.0%; risk ratio 3.51, 95% CI 1.85–6.66; P<0.001). After adjustment for age, sex, diabetes,hypertension, ASA physical status, haemoglobin and operative duration, hypoalbuminaemia remained associated with SSI (adjusted odds ratio 4.79, 95% CI 2.23–10.31; P<0.001). Conclusion: Preoperative hypoalbuminaemia was associated with increased odds of SSI after emergency exploratory laparotomy. Albumin may contribute to perioperative risk assessment, although causality cannot be inferred. Keywords: hypoalbuminaemia; serum albumin; surgical site infection; emergency laparotomy; postoperative complications.