Introduction: Hypoalbuminemia ( < 3.5 g/dL) is common in patients undergoing cardiac surgery and reflects poor nutritional status and inflammation. Albumin helps maintain oncotic pressure, vascular integrity, and supports coagulation. Low levels may increase bleeding risk. This quality improvement project examined whether preoperative hypoalbuminemia is associated with higher intraoperative transfusion needs.
Methods: We retrospectively analyzed 24,005 adult patients who underwent cardiac surgery with cardiopulmonary bypass or off-pump CABG between January 2018 and June 2024 at a single center. Patients were grouped by preoperative serum albumin: < 3.5 g/dL (low), 3.5–4.0 g/dL (borderline), and >4.0 g/dL (normal). Intraoperative transfusions of red blood cells (RBCs), platelets, fresh frozen plasma (FFP), and cryoprecipitate were compared. Multivariable logistic regression adjusted for age, comorbidities, anemia, surgical type, and bypass time.
Results: RBC transfusion occurred in 52.1% of patients with low albumin, 38.3% in the borderline group, and 27.6% in the normal group. Platelet and FFP use followed the same trend. Patients with hypoalbuminemia also had longer bypass times and received more total blood products. After adjustment, low albumin remained independently associated with increased transfusion across all product types.
Conclusions: Preoperative hypoalbuminemia was associated with higher intraoperative transfusion rates across all major blood products. Identifying albumin level as a modifiable risk marker may help target patients for early nutrition assessment and support. Incorporating albumin into preoperative evaluations could inform blood management strategies and support efforts to reduce transfusion burden in cardiac surgery.
