Prognostic impact of pre-operative albumin on short-term mortality and complications in patients with hip fracture

Low serum albumin may have prognostic value for morbidity and mortality in patients with hip fracture. The primary aim of the study was to evaluate the independent association between low serum albumin (<35 g/l) at hospital admission and short-term (in-hospital) mortality and post-operative complications of patients with hip fracture. We reviewed a prospective population-based cohort of 583 hip fracture patients who had pre-operative albumin values measured at hospital admission in one of the 3 tertiary hospitals in Northern Alberta, Canada. Patients with a primary diagnosis of hip fracture and 65 years or older were included. The primary outcomes were in-hospital mortality and any pre-specified post-operative complication. Mean serum albumin level was 33.8 ± 4.5 g/l (±S.D.), and overall 55% (n = 318) of patients had a low albumin. The in-hospital mortality was 8% (n = 46) and rate of any non-fatal post-operative complication rate was 31/100. Mortality was 11% (n = 35) among those with low albumin levels and 4% (n = 11) for those with normal values (unadjusted odds ratio (OR) 2.86, 95% CI = 1.42–5.74). After multivariate adjustment, the association between low serum albumin and mortality remained large and statistically significant (adjusted OR = 2.44, 95% confidence interval (CI) = 1.17–5.12). Low albumin levels were also significantly associated with post-operative medical complications (adjusted OR = 1.96, 95% CI = 1.36–2.83). We conclude that routine measurement of serum albumin provides valuable prognostic information for treating this frail population.