The implications of preoperative hypoalbuminemia on postoperative readmission, reoperation, and mortality among orthopaedic trauma patients: A systematic review and meta-analysis.

Background/aims: Preoperative serum hypoalbuminemia (<3.5 g/dL) is the blanketed referenced threshold associated with postoperative readmission, reoperation, and mortality among medical and surgical patients. This systematic review and meta-analysis evaluates the specific role of preoperative serum albumin and readmission, reoperation, and mortality among orthopaedic trauma patients.

Methods: PubMed/MEDLINE, Embase, Ovid, Cochrane Central Register of Controlled Trials (CENTRAL) the trial register (clinicaltrials.gov), and Scopus were searched for eligible studies meeting the following criteria: 1) retrospective and prospective observational studies or randomized controlled trials (RCTs), 2) adult patients with orthopaedic traumatic THA,TKA,TSA; 3) comparative cohort evaluation of patients with and without baseline hypoalbuminemia and postoperative readmission, reoperation, and mortality rates. The PROSPERO number is CRD420251053172.

Results: Nine studies were included. A meta-analysis of eight studies found hypoalbuminemia to have 2.42-fold (95 % CI = 1.75-3.34) increased risk of post-operative mortality. Meta-analyses of three studies found that hypoalbuminemia was associated with a 1.74-fold (95 % CI = 1.32-2.29) and 1.96-fold (95 % CI = 1.11-3.48) respective increase in reoperation and readmission. Subgroup analysis of four studies that treated patients with arthroplasty and three studies that treated patients without arthroplasty found a 1.77-fold (95 % CI = 1.46-2.13). and = 4.02 (95 % CI = 1.77-13.86) risk of postoperative mortality, respectively.

Conclusion: While baseline hypoalbuminemia is significantly associated with postoperative readmission, reoperation, and mortality among orthopaedic trauma patients, we caution against the use of a single albumin threshold to assess postoperative risk.