title: Hypoalbuminaemia-a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures.
abstract: OBJECTIVE
  Our aim was to determine the effect of hypoalbuminaemia as a marker of malnutrition on the 30-day postoperative complication rate and mortality in patients receiving surgical treatment for hip fractures using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
  
  
  METHODS
  We analyzed all patients admitted with hip fractures receiving surgical treatment from 2011 to 2013. Patients were dichotomized based on their albumin levels; hypoalbuminaemia (albumin <3.5g/dL), and nonhypoalbuminaemia (albumin >3.5g/dL). Patient demographics, postoperative complications, and length of stay were analysed. Logistic regression analysis was conducted to assess the ability of albumin level for predicting postoperative complications, length of stay, and mortality.
  
  
  RESULTS
  A total of 10,117 patients with hip fractures were identified with 5414 patients with normal albumin levels, and 4703 with low albumin. Multivariate analysis showed that when controlling for comorbidities; hypoalbuminaemia alone was a predictor of postoperative complications (death, unplanned intubation, being on a ventilator >48h, sepsis, and blood transfusion), and increased length of stay (6.90±7.23 versus 8.44±8.70, CI 0.64-1.20, P<0.001).
  
  
  CONCLUSIONS
  Hypoalbuminaemia alone can predict postoperative outcomes in patients with hip fractures. Furthermore, patients with hypoalbuminaemia had a longer hospital length of stay. Further studies are needed to assess whether nutritional support can improve postoperative complications in patients with hypoalbuminaemia.
authors.affiliation: Division of Orthopaedics, McGill University Health Center, Montreal, Canada; National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia. Electronic address: sultan.aldebeyan@gmail.com.
authors.forename: Sultan
authors.initials: S
authors.lastname: Aldebeyan
authors.affiliation: Division of Orthopaedics, McGill University Health Center, Montreal, Canada; Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Anas
authors.initials: A
authors.lastname: Nooh
authors.affiliation: Division of Orthopaedics, McGill University Health Center, Montreal, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aoude
authors.affiliation: Division of Orthopaedics, McGill University Health Center, Montreal, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weber
authors.affiliation: Division of Orthopaedics, McGill University Health Center, Montreal, Canada.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Harvey
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications / Q000175:diagnosis* / Q000178:diet therapy; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000178:diet therapy* / Q000601:surgery; D044623:Nutrition Therapy / Q000379:methods*; D011183:Postoperative Complications / Q000178:diet therapy* / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: 30-day mortality; Hip fractures; Hypoalbuminaemia; Malnutrition