Importance of serum albumin level in the preoperative tests conducted in elderly patients with hip fracture.

Background: Preoperative testing is commonly performed in patients undergoing surgery for hip fractures. The purpose of this study was to determine the appropriate preoperative tests after implementation of the case-payment reimbursement system and clinical pathway.

Methods: We analysed 242 patients admitted to a regional hospital for hip fracture. Preoperative comorbidities and laboratory test results were measured and evaluated for their association with the occurrence of postoperative adverse outcomes.

Results: Univariate analysis showed that abnormal chest X-ray, haemoglobin, albumin, and total protein were associated with concomitant pulmonary diseases. Abnormal electrocardiogram (ECG), Na, creatinine, and aspirate aminotransferase (AST) levels were associated with heart disease. On the base of the univariate analysis, the significant preoperative variables for increased postoperative complications at 30 days included abnormal chest X-ray (odds ratio, 4.45; 95% confidence interval (CI), 2.24-8.84), ECG (odds ratio, 3.95; 95% CI, 1.96-7.95), Hct (odds ratio, 2.22; 95% CI, 0.96-5.16), Hb (odds ratio, 2.68; 1.29-5.58), blood urine nitrogen (odds ratio, 2.69; 95% CI, 1.34-5.42), creatinine (odds ratio, 4.49; 2.31-8.75), albumin (odds ratio, 9.68; 95% CI, 3.16-29.65), and AST (odds ratio, 2.36; 95% CI, 1.12-4.98). After adjustment for age, sex, and comorbidities, the risk factors that improved the predictability of postoperative complications were found to be abnormal chest X-ray (odds ratio, 6.03; 95% CI, 1.84-19.82) and albumin level (odds ratio, 6.23; 95% CI, 1.90-20.42).

Conclusion: Serum albumin level and preoperative chest X-rays should be included in the preoperative routine tests recommended for elderly patient with hip fracture.