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Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture.
J Bone Joint Surg Am. 2017 12 20; 99(24):2110-2118.JB

Abstract

BACKGROUND

Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration <3.5 g/dL considered to be suggestive of malnutrition. The purpose of this study was to test if serum albumin level is associated with death, specific postoperative complications (e.g., pneumonia), length of hospital stay, and readmission following a surgical procedure for geriatric hip fracture.

METHODS

A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator.

RESULTS

There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]), sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean length of stay (and standard deviation) was longer among patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21).

CONCLUSIONS

Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest that further investigation into postoperative nutritional supplementation is warranted to decrease the risk of complications.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.University of North Carolina School of Medicine, Chapel Hill, North Carolina.Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29257017

Citation

Bohl, Daniel D., et al. "Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture." The Journal of Bone and Joint Surgery. American Volume, vol. 99, no. 24, 2017, pp. 2110-2118.
Bohl DD, Shen MR, Hannon CP, et al. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. J Bone Joint Surg Am. 2017;99(24):2110-2118.
Bohl, D. D., Shen, M. R., Hannon, C. P., Fillingham, Y. A., Darrith, B., & Della Valle, C. J. (2017). Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. The Journal of Bone and Joint Surgery. American Volume, 99(24), 2110-2118. https://doi.org/10.2106/JBJS.16.01620
Bohl DD, et al. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. J Bone Joint Surg Am. 2017 12 20;99(24):2110-2118. PubMed PMID: 29257017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture. AU - Bohl,Daniel D, AU - Shen,Mary R, AU - Hannon,Charles P, AU - Fillingham,Yale A, AU - Darrith,Brian, AU - Della Valle,Craig J, PY - 2017/12/20/entrez PY - 2017/12/20/pubmed PY - 2017/12/28/medline SP - 2110 EP - 2118 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 99 IS - 24 N2 - BACKGROUND: Serum albumin level is the most well-established serum marker of malnutrition, with a serum albumin concentration <3.5 g/dL considered to be suggestive of malnutrition. The purpose of this study was to test if serum albumin level is associated with death, specific postoperative complications (e.g., pneumonia), length of hospital stay, and readmission following a surgical procedure for geriatric hip fracture. METHODS: A retrospective cohort study of geriatric patients (≥65 years of age) undergoing a hip fracture surgical procedure as part of the American College of Surgeons National Surgical Quality Improvement Program was conducted. Outcomes were compared between patients with and without hypoalbuminemia. All comparisons were adjusted for baseline and procedural differences between populations, and patients with missing serum albumin concentration were included in analyses using a missing data indicator. RESULTS: There were 29,377 geriatric patients undergoing a hip fracture surgical procedure who met inclusion criteria; of these patients, 17,651 (60.1%) had serum albumin available for analysis. The prevalence of hypoalbuminemia was 45.9%. Following adjustment for baseline and procedural characteristics, the risk of death was inversely associated with serum albumin concentration as a continuous variable (adjusted relative risk, 0.59 [95% confidence interval (CI), 0.53 to 0.65]; p < 0.001). In comparison with patients with normal albumin concentration, patients with hypoalbuminemia had higher rates of death (9.94% compared with 5.53% [adjusted relative risk, 1.52 (95% CI, 1.37 to 1.70); p < 0.001]), sepsis (1.19% compared with 0.53% [adjusted relative risk, 1.92 (95% CI, 1.36 to 2.72); p < 0.001]), and unplanned intubation (2.64% compared with 1.47% [adjusted relative risk, 1.51 (95% CI, 1.21 to 1.88); p < 0.001]). The mean length of stay (and standard deviation) was longer among patients with hypoalbuminemia at 5.67 ± 4.68 days compared with those without hypoalbuminemia at 4.99 ± 3.95 days; the adjusted difference was 0.50 day (95% CI, 0.38 to 0.63 day; p < 0.001). However, the rate of readmission did not differ (p = 0.054) between patients with hypoalbuminemia (10.91%) and those without hypoalbuminemia (9.03%); the adjusted relative risk was 1.10 (95% CI, 1.00 to 1.21). CONCLUSIONS: Hypoalbuminemia is a powerful independent risk factor for mortality following a surgical procedure for geriatric hip fracture. These data suggest that further investigation into postoperative nutritional supplementation is warranted to decrease the risk of complications. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/29257017/Serum_Albumin_Predicts_Survival_and_Postoperative_Course_Following_Surgery_for_Geriatric_Hip_Fracture_ L2 - http://dx.doi.org/10.2106/JBJS.16.01620 DB - PRIME DP - Unbound Medicine ER -