METHODS: A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture
surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without
hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing
serum albumin concentration were included in analyses using a missing data
indicator.
RESULTS: There were 29,377 geriatric patients undergoing a hip fracture
surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had
serum albumin available for analysis. The prevalence of
hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with
serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal
albumin concentration, patients with
hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]),
sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean
length of stay (and standard deviation) was longer among patients with
hypoalbuminemia at 5.67 ± 4.68 days compared with those without
hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with
hypoalbuminemia (10.91%) and those without
hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21).
CONCLUSIONS: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.