Hypoalbuminemia increases complications in elderly patients operated for hip fracture

Abstract

Background: Hip fracture is a major cause of morbidity and mortality in elderly people. A drop in serum albumin after hip surgery has been reported, but few data are available on the effect on complications. The aim of this study was to assess the role of two distinct orthopedic surgical procedures (fixation or prosthesis) and pre-surgery albumin serum level on the development of clinical complications.

Methods: Of 176 subjects aged 65 and older with hip fracture hospitalized either in orthopedics or geriatrics ward in a 15-month period, the data of 152 patients were analyzed. Interventions were fixation or prosthesis. Measurements included gender, age, surgical procedure, medical complications, admission albumin level (g/L), and post-surgical albumin level (g/L).

Results: All patients (n = 152), regardless of the surgical procedure, underwent a loss of albumin from (mean ± standard deviation) 32.6 ± 4.3 to 25.0 ± 3.8 g/L. Complications were associated with albumin level both at pre-surgery (no complications mean ± SD 33.9 ± 3.5 g/L; n = 80; complications mean ± SD 31.2 ± 4.7 g/L; n = 72; p < 0.001) and post-surgery (no complications mean ± SD 26.2 ± 3.5 g/L; n = 80; complications mean ± SD 23.7 ± 3.6 g/L; n = 72; p < 0.001). When considering a multivariable model, an increased risk in the incidence of complications was found in subjects with preoperative albumin below 30 g/L (reference albumin greater than or equal to 30 g/L; OR 3.74; CI 95% 1.43-9.80) and in subjects undergoing prosthesis procedure (reference: fixation; OR 1.97; CI 95% 1.00-3.88).

Conclusions: We observed that fixation and prosthesis were associated with a decrease in albumin level. Given a low pre-surgery level of albumin, the risk of complications was higher than in patient with pre-surgery normal level of albumin. This pilot study suggests further prospective research, considering whether albumin administration could be effective in preventing a fall in the albumin level after surgery, thus reducing the postoperative complication rate.

Keywords: Aging; Hip fracture; Hypoalbuminemia; Surgery.