Postoperative Hypoalbuminemia as a Predictor of Early Mortality After Cementless Hemiarthroplasty for Hip Fractures

<i>Background and Objectives:</i> This study aimed to evaluate the factors influencing early postoperative mortality in patients undergoing cementless hemiarthroplasty for proximal femoral fractures. <i>Materials and Methods:</i> The medical records of 227 patients treated between January 2019 and December 2020 were retrospectively reviewed. Patients were divided into two groups: survivors (Group 1, <i>n</i> = 160) and non-survivors (Group 2, <i>n</i> = 67). The variables assessed included demographic data, neutrophil-to-lymphocyte ratio, surgical duration, hospital stay, American Society of Anesthesiologists (ASA) score, cardiac ejection fraction (EF), Charlson Comorbidity Index (CCI), osteoporosis status, and hemoglobin and albumin levels. Clinical evaluation was performed using the Harris Hip Score. Binary logistic regression was used to analyze risk factors; receiver operating characteristic (ROC) analysis was applied to determine cutoff values. <i>Results:</i> The mean follow-up duration was 14.03 ± 10 months. The mean ages were 80 ± 7.68 yr in Group 1 and 83.99 ± 7.42 yr in Group 2. Statistically significant differences were found between groups regarding ASA scores, intensive care unit (ICU) admission rates, and osteoporosis status (<i>p</i> < 0.001). Preoperative and postoperative albumin levels were also significantly different (<i>p</i> < 0.001). The 1-year and 6-month mortality rates were 39.6% and 29.5%, respectively. Univariate analysis identified age, EF, ASA score, preoperative and postoperative albumin levels, CCI, ICU admission, and ICU stay duration as mortality-related factors. Multivariate binary logistic regression analysis revealed that low postoperative albumin levels may have a significant effect on mortality at 1, 3, and 6 months. ROC analysis showed a significant albumin cutoff value of 2.95 g/dL. <i>Conclusions:</i> Higher postoperative albumin levels were inversely associated with early mortality following hemiarthroplasty in elderly patients. Perioperative monitoring of albumin levels may help improve outcomes, particularly in individuals with severe comorbidities.