Hip fractures are common in elderly patients, and which surgical modality to pursue is often debated. Malnutrition, which cannot be corrected preoperatively in this population, is often not considered. Therefore, the authors sought to investigate the association between hypoalbuminemia and postoperative outcomes based on surgical intervention. Patients undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty), open reduction and internal fixation, and intramedullary nailing placement for treatment of hip fractures were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by preoperative albumin level, with less than 3.5 g/dL indicating hypoalbuminemia. Albumin's association with postoperative complications was evaluated with multivariate logistic regression controlling for patient age, body mass index, American Society of Anesthesiologists score, and functional independence. A total of 20,278 patients with hip fractures and available albumin levels were included. Multivariate analysis revealed hypoalbuminemia was predictive of readmission, reintubation, mortality, and length of stay for all surgeries performed. When analyzing across surgical modalities, unique complications were identified for patients with hypoalbuminemia undergoing open reduction and internal fixation/prosthetic replacement (reoperation, P<.001) and arthroplasty (any infection, P=.028) compared with other treatment options. Hypoalbuminemia can predict postoperative complications for patients with hip fractures and should be considered preoperatively to guide surgical decision making in equivocal cases where multiple modalities may be used based on fracture pattern. This study supports that, compared with other interventions, intramedullary nailing is associated with fewer postoperative complications in patients with hypoalbuminemia. [Orthopedics. 2018; 41(6):e789-e796.].
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