Dunavan Morris-Janzen

Dr. Dunavan Morris-Janzen

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Research Focus & Metrics

Academic Career Length

3Years (2024-Present)

(Calculated once Scilit publication data is synced: current year − year of first publication + 1)

Representative Publications

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7 October 2024 in Livers
Verified
Journal Article
Open access
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DMDunavan Morris-Janzen
Dunavan Morris-Janzen
SJSukhdeep Jatana
Sukhdeep Jatana
KVKevin Verhoeff
Kevin Verhoeff
ASAndrew Mark James Shapiro
Andrew Mark James Shapiro
DBDavid Bigam
David Bigam
BABlaire Anderson
Blaire Anderson
Background/Objectives: Efforts to preoperatively risk stratify and optimize patients before liver resection allow for improvements in postoperative outcomes, with hypoalbuminemia being increasingly researched as a surrogate for nutrition, overall health and functional status. Given the paucity of studies examining the relationship between hypoalbuminemia and liver resection, this study aims to determine the impact of hypoalbuminemia on outcomes following liver resections using a large multicenter database. Methods: The American College of Surgeons–National Surgical Quality Improvement Program (2017–2021) database was used to extract the data of patients who underwent a hepatic resection. Two cohorts were defined; those with hypoalbuminemia (HA; <3.0 g/L) and those with normal albumin levels (≥3.0 g/L). Both baseline characteristics and 30-day postoperative complication rates were compared between the two cohorts. Multivariable logistic regression models were used to assess the independent effect of HA on various outcomes. Area under curve–receiver operating characteristic (AUC-ROC) curves were used to identify optimal albumin thresholds for both serious complications and mortality. Results: We evaluated 26,394 patients who underwent liver resections, with 1347 (5.1%) having preoperative HA. The HA patients were older (62.3 vs. 59.8; p < 0.001) and more likely to be of an ASA class ≥ 4 (13.0% vs. 6.5%; p < 0.001). The patients with HA had significantly more complications such as an increased length of stay, readmission, reoperation, sepsis, surgical site infection, bile leak, and need for transfusion. After controlling for demographics and comorbidities, HA remained a significant independent predictor associated with both 30-day serious complication rates (aOR 2.93 [CI 95% 2.36–3.65, p < 0.001]) and mortality (aOR 2.15 [CI 95% 1.38–3.36, p = 0.001]). The optimal cut-off for albumin with respect to predicting serious complications was 4.0 g/dL (sensitivity 59.1%, specificity 56.8%, AUC-ROC 0.61) and 3.8 g/dL (sensitivity 56.6%, specificity 68.3%, AUC-ROC 0.67) for mortality. Conclusions: In this large, retrospective database analysis, preoperative HA was significantly associated with 30-day morbidity and mortality rates following hepatic resection. Preoperative albumin may serve as a useful marker for risk stratification in conjunction with pre-existing calculators. Future studies evaluating the risk mitigation impact of nutrition and exercise prehabilitation in these patients and its capacity to modify hypoalbuminemia would be beneficial.