Objective:

To explore the relationship between ΔAlb and postoperative complications, and evaluate a multifactorial predictive model for severe complications.

Approach:

• Study Design: Retrospective analysis of 932 patients undergoing colorectal cancer resection from August 2020 to April 2022.
• Data Collection: Included preoperative/postoperative albumin levels, demographics, surgical/anesthetic details, and 30-day complications.
• Statistical Analysis: Assessed ΔAlb's association with severe complications via logistic regression and developed a nomogram.

Key Findings:

• Severe complications occurred in 14.2% of patients.
• ΔAlb showed no significant association with severe complications (P = 0.185).
• Preoperative albumin <35 g/L and POD2 nadir albumin <28.5 g/L were independent risk factors.
• Other independent predictors included age >65 years, ASA ≥3, preoperative NRS2002 ≥2, and rocuronium dose ≥117.5 mg.
• The nomogram integrating these factors showed good discrimination and calibration.

Interpretation:

ΔAlb alone has limited predictive value, while absolute preoperative and early postoperative albumin levels are significant predictors of severe complications.

Limitations:

• The study is retrospective and may have inherent biases.
• Findings require prospective, multicentre validation.

Conclusion:

A multifactorial model improves prediction of severe complications compared to individual factors.