Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2025
Is Preoperative Serum Albumin Associated With Medication Related Osteonecrosis of the Jaw Severity and Surgical Outcomes?
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Fuller Adam, Nadella Srighana, Hatzipetrou Georgios, He Puhan, Theken Katherine N, Panchal Neeraj
Аннотация
BACKGROUND: Preoperative serum albumin is a widely recognized marker of postoperative outcomes across various surgical conditions, with lower levels associated with worse outcomes. However, its prognostic value in medication-related osteonecrosis of the jaw (MRONJ) remains unexplored.
PURPOSE: The purpose of the study was to evaluate the association between preoperative albumin levels and both surgical outcomes and MRONJ severity at presentation.
STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study was conducted on subjects treated for MRONJ under the Oral and Maxillofacial Surgery service at the University of Pennsylvania Health System between January 1, 2013, and September 12, 2022. Inclusion criteria were a confirmed MRONJ diagnosis, surgical management, and preoperative serum albumin level measured within 3 months of surgery. Subjects without at least one postoperative follow-up were excluded.
PREDICTOR VARIABLE: The primary predictor variable was preoperative serum albumin within 3 months of surgery.
MAIN OUTCOME VARIABLES: The primary outcome variable was surgical outcome in MRONJ, characterized as improved (resolved or downstaged) versus not improved (same stage, upstaged, and/or with complications).
COVARIATES: Covariates included demographic variables (age, sex, race) and clinical factors (MRONJ stage, history of osteoporosis, cancer, penicillin allergy, diabetes, smoking) for MRONJ.
ANALYSIS: Multiple logistic regression and analysis of variance models were used to assess associations between serum albumin and surgical outcomes. Statistical significance was defined at P < .05.
RESULTS: The sample was composed of 94 subjects with a mean age of 68.1 ± 10.3 years; 31 (33.0%) were male. The mean preoperative albumin level was 3.84 ± .43 g/dl. The unadjusted associated albumin levels were statistically significantly lower in the group with poor surgical outcomes (3.51 ± 0.457 g/dl) compared to the improved group (3.90 ± 0.394 g/dl; P < .05). After adjusting for all the covariates, albumin was statistically significantly associated with improved outcomes (OR: 0.0928; 95% CI: 0.0138 to 0.489; P < .05).
CONCLUSIONS AND RELEVANCE: In one of the largest surgical MRONJ cohorts to date, there was a statistically significant association between lower preoperative serum albumin levels and poorer surgical outcomes.
PURPOSE: The purpose of the study was to evaluate the association between preoperative albumin levels and both surgical outcomes and MRONJ severity at presentation.
STUDY DESIGN, SETTING, SAMPLE: A retrospective cohort study was conducted on subjects treated for MRONJ under the Oral and Maxillofacial Surgery service at the University of Pennsylvania Health System between January 1, 2013, and September 12, 2022. Inclusion criteria were a confirmed MRONJ diagnosis, surgical management, and preoperative serum albumin level measured within 3 months of surgery. Subjects without at least one postoperative follow-up were excluded.
PREDICTOR VARIABLE: The primary predictor variable was preoperative serum albumin within 3 months of surgery.
MAIN OUTCOME VARIABLES: The primary outcome variable was surgical outcome in MRONJ, characterized as improved (resolved or downstaged) versus not improved (same stage, upstaged, and/or with complications).
COVARIATES: Covariates included demographic variables (age, sex, race) and clinical factors (MRONJ stage, history of osteoporosis, cancer, penicillin allergy, diabetes, smoking) for MRONJ.
ANALYSIS: Multiple logistic regression and analysis of variance models were used to assess associations between serum albumin and surgical outcomes. Statistical significance was defined at P < .05.
RESULTS: The sample was composed of 94 subjects with a mean age of 68.1 ± 10.3 years; 31 (33.0%) were male. The mean preoperative albumin level was 3.84 ± .43 g/dl. The unadjusted associated albumin levels were statistically significantly lower in the group with poor surgical outcomes (3.51 ± 0.457 g/dl) compared to the improved group (3.90 ± 0.394 g/dl; P < .05). After adjusting for all the covariates, albumin was statistically significantly associated with improved outcomes (OR: 0.0928; 95% CI: 0.0138 to 0.489; P < .05).
CONCLUSIONS AND RELEVANCE: In one of the largest surgical MRONJ cohorts to date, there was a statistically significant association between lower preoperative serum albumin levels and poorer surgical outcomes.