Serum Albumin Predicts Death in Hip Surgery

Think there’s not much room for improvement in hip fracture surgery? Think again. Daniel Bohl, M.D., M.P.H. and Craig Della Valle, M.D., researchers at Rush University Medical Center, are drilling down to understand how nutrition influences the outcomes of geriatric hip fracture surgery.

Dr. Bohl told OTW, “Hip fracture surgery has come a along way in terms of operative technique, but many patients still struggle with medical complications following surgery—things like infections, blood clots, and even death. Before most hip fracture procedures, we get a range of lab results and values as part of a general screening. One of these is serum albumin concentration. Most often, surgeons don’t attend to this, and serum albumin is better known for its role in assessing nutritional status in the public health arena. However, we are investigating how serum albumin might play a role in the risk for complications following surgery.”

Their study was a retrospective look at associations between serum albumin concentration and complications during the 30 days following geriatric hip fracture surgery. The authors compared outcomes between patients with and without hypoalbuminemia, and found that the risk for death was strongly associated with serum albumin concentration.

“Out of all of the preoperative variables we examined, serum albumin was one of the most powerful predictors for adverse complications, in particular death. While our study can’t suggest a particular mechanism, we can say that poor nutrition suggests an impaired physiologic state in the person who has sustained a proximal femoral fracture. Low serum albumin concentration indicates that there is a lower likelihood of having a good result.”

“In many of these geriatric patients, a hip fracture represents a step in a functional and physiologic downward spiral. The fact that so many of the patients in our study were malnourished—46%—is indicative of just that. Patients with hypoalbuminemia may be further along in that downward spiral, and these patients are the ones most likely to benefit from nutritional intervention during the hours prior to and months following surgery.”

Dr. Bohl says that future work will involve optimization of perioperative nutritional interventions for these patients at high risk of postoperative morbidity and mortality.