The nonlinear correlation between serum albumin to creatinine ratio and length of stay in patients undergoing pylorus-preserving pancreaticoduodenectomy: A retrospective study.

The serum albumin to creatinine ratio (sACR) has emerged as a potential biomarker for predicting postoperative outcomes, yet its relationship with length of stay (LOS) in patients undergoing pylorus-preserving pancreaticoduodenectomy (PPPD) remains underexplored. This study aimed to investigate the nonlinear correlation between sACR and LOS in this patient population. A secondary analysis was conducted on retrospective data from 809 patients who underwent PPPD. LOS was dichotomized into short (≤ 41 days) and long (> 41 days) based on the median value. sACR was calculated as the ratio of serum albumin (g/L) to serum creatinine (μmol/L). Demographic, clinical, laboratory, and perioperative variables were analyzed. Threshold effect analysis was performed using a 2-piecewise linear regression model to identify potential inflection points in the sACR-LOS relationship. Multivariate adjustments were made for demographic, clinical, and laboratory variables to control for confounding factors. A significant nonlinear relationship between sACR and LOS was identified, with an inflection point at 33.64. In patients with sACR levels below 33.64, each unit increase in sACR was associated with a 13% reduction in the odds of prolonged LOS (odds ratio = 0.87, 95% CI: 0.76-0.99, P = .038). No significant association was observed above this threshold (odds ratio = 1.03, 95% confidence interval: 0.99-1.08, P = .118). This study demonstrates a critical threshold effect of sACR on LOS in PPPD patients, highlighting its potential as a predictive biomarker for postoperative recovery. Optimizing sACR levels, particularly in patients with values below 33.64, may reduce the risk of prolonged hospitalization.