The impact of preoperative serum albumin on postoperative recovery and healthrelated quality of life in older hip fracture patients.

Abstract

The primary objective was to evaluate the predictive value of serum albumin levels for long-term functional recovery after hip fracture surgery. Data from a university hospital's Fracture Liaison Service Registry (2016-2021) were retrospectively analyzed. Hypoalbuminemia was defined as a serum albumin level below 35 g/L upon admission, in line with established clinical thresholds from previous studies. Functional outcomes were assessed at baseline, 3 months, and 1 year after surgery using the Barthel Index to measure basic activities of daily living and the EuroQol Visual Analog Scale to assess overall health-related quality of life. Multivariate logistic regression identified risk factors for poor Barthel Index scores (<60) at 1 year postoperatively. The analysis included 1086 patients (mean age 79.9 years, 75.8% female) with a 28.9% prevalence of hypoalbuminemia (309 patients). All functional outcomes improved over the 1-year follow-up. However, in the hypoalbuminemia group, gains in quality of life plateaued after the first 3 months. Lower serum albumin and a higher comorbidity burden were associated with unfavorable long-term functional recovery. A serum albumin level below 38 g/L (identified using the Youden Index) emerged as a threshold for predicting poor outcomes with Area Under Curve of 0.62. Older adults with serum albumin levels below 38 g/L may be at increased risk of poor functional recovery following hip fracture surgery. Although hypoalbuminemia is traditionally defined as levels below 35 g/L, the findings suggest that adverse outcomes may begin to emerge at slightly higher levels. Early recognition of this risk, along with timely nutritional and rehabilitative interventions around the 38 g/L threshold, may help support improved long-term outcomes and reduce post-fracture disability   Cite this article as: Sirichativapee W, Chotiyarnwong P, Unnanuntana A, Vanitcharoenkul E. The impact of preoperative serum albumin on postoperative recovery and health-related quality of life in older hip fracture patients. Acta Orthop Traumatol Turc., 2026, 60(1), 0253, doi:10.5152/j.aott.2025.25253.