Title : The association between pre-operative albumin levels and post-operative outcomes in neck of femur fracture surgery: A single-centre retrospective study
Abstract:
Introduction: Neck Of Femur Fracture (NOFF) are common presentations to the accident and emergency department. Timely intervention is essential to prevent further complications due to prolong immobility. Guidelines have been developed over the years to help manage NOFF patients efficiently and to minimise complications. Recent studies have shown low albumin levels may correlate with a high mortality rate in the short term in NOFF patients. This study aimed to assess the correlation between hypoalbuminaemia, mortality and/or Length Of Stay (LOS) in patients who underwent surgery for Neck of femur fracture.
Materials and Methods: A retrospective study of patients with neck of femur fractures admitted to Kettering General Hospital between November 2024 and March 2025 was conducted. Data on patient demographics, comorbidities (including underlying dementia), ASA grade, pre-operative albumin levels, and outcomes (mortality, length of stay) were collected from care flow connect and the national hip fracture database.
Results: A total of 113 patients were identified. Mean age at presentation was 81 years (age range (yrs): 60-99). Three patients were excluded from the analysis due to being managed conservatively (n=1), dying before surgery (n=1) or no availability of pre-operative albumin levels (n=1), leaving a total cohort of 67 females (60.4%) and 44 males (39.6%). A minority of patients (n=6) were found to have low albumin levels pre-operatively, with the majority (n=104) having normal levels. Four patients with normal pre-operative albumin levels died within 30 days of their operation. The majority of these patients were known to have dementia (n=3). They also had underlying comorbidities such as cardiovascular (n=6), endocrine (n=1) and renal problems (n=2). No patients with low albumin levels died within 30 days of their operation. Hypoalbuminaemia was associated with a longer LOS (44.2 vs. 20.1 days).
Conclusion: This study found no statistically significant association between hypoalbuminaemia and 30-day mortality in patients undergoing surgery for neck of femur fractures, supporting the null hypothesis that albumin level does not influence short-term mortality in this cohort. However, hypoalbuminaemia was significantly associated with a longer hospital length of stay, suggesting that while albumin may not directly predict early mortality, it may still reflect poorer physiological reserve and increased vulnerability to prolonged postoperative recovery. Further research with a larger sample size is required to clarify the relationship between albumin, postoperative outcomes, and potential confounding factors.
