Perioperative albumin drop is a marker for surgical stress and correlate with clinical outcomes in the elderly patients undergoing hip arthroplasty for femoral neck fractures

Abstract

Background This single-center retrospective study investigated the correlation between the drop of perioperative albumin and clinical outcomes in the elderly patients undergoing hip arthroplasty for femoral neck fractures (FNF). Methods We investigated 278 patients 65 years of age or older who had undergone hip arthroplasty with FNF between January 2021 and March 2023. Albumin, C-reactive protein (CRP) and hemoglobin were monitored on preoperation, postoperative day-0, day-1 and day-7. The decrease of perioperative albumin (ΔAlb) was calculated by subtracting the value on day-0 from preoperation. Then patients were divided into two groups based on the ΔAlb values, with ΔAlb < 0.5 g/dL and ΔAlb ≥ 0.5 g/dL in group 1 and group 2, respectively. Results The albumin declined 0.8 g/dL from preoperation to day-1 and slowly increased by 0.3 g/dL from day-1 to day-7. The patients in group 2 had longer duration of surgery (75 minutes vs 65 minutes, P = 0.028), more intraoperative blood loss (246.7 ± 78.4 mL vs 201.5 ± 59.8 mL, P = 0.031) and changes of CRP (75.2 ± 48.1 mg/L vs 54.9 ± 44.9 mg/L, P = 0.003) comparing with the patients in group 1. Patients in group 2 had higher prevalences of postoperative complications (hypoalbuminemia: 94% vs 15%, moderate-severe anaemia: 60% vs 40%, P < 0.05) and longer postoperative length of stay (14 days vs 13 days, P = 0.045). The ΔAlb value was correlated with the duration of surgery (r= 0.3, P < 0.001), intraoperative blood loss (r = 0.2, P< 0.001), ΔCRP (r = 0.4, P < 0.001) and postoperative LOS (r= 0.2, P = 0.003). Conclusions The levels of albumin decreased significantly after surgery, while the CRP increased. Further, the perioperative albumin drop was a marker for surgical stress and correlated with adverse clinical outcomes.