Serum Albumin Levels Are Independently Associated With Length of Stay and Readmission in Patients With Renal Cell Carcinoma

Purpose: Serum albumin is a well-established surrogate marker of nutritional and systemic health. Among patients with renal cell carcinoma (RCC), hypoalbuminemia is associated with increased mortality; however, its correlation with hospital length of stay (LOS) and readmission remains poorly characterized. This study aims to evaluate the association between preoperative hypoalbuminemia, LOS, and 90-day readmission in patients undergoing nephrectomy. Materials and Methods: We reviewed a prospectively maintained RCC database at our institution for patients undergoing nephrectomy between 2000 and 2025. Inclusion criteria were age 18 or older and nonmetastatic RCC (T1–3N0M0). Multivariable logistic and negative binomial regression models were used to assess predictors of prolonged LOS (≥7 days) and 90-day readmission. Albumin was evaluated as both a continuous and categorical variable (<3.5 vs ≥3.5 g/dL). Results: Among 1774 patients, 14.8% had hypoalbuminemia (<3.5 g/dL), 12.9% experienced prolonged LOS, and 10.1% were readmitted within 90 days. On linear regression, lower serum albumin was significantly associated with longer LOS (B = −1.67 days per g/dL, P < 0.001). On multivariable analysis, hypoalbuminemia was independently associated with increased odds of prolonged LOS (OR 1.65, 95%CI 1.13-2.42, P = .01) and readmission (OR 1.61, 95%CI 1.06-2.44, P = .03). Similar results were noted on multivariable negative binomial regression. Conclusions: Preoperative hypoalbuminemia is independently associated with prolonged hospitalization and increased risk of 90-day readmission in patients undergoing nephrectomy for nonmetastatic RCC. Serum albumin may serve as a valuable risk stratification tool. Nutritional optimization and integration of albumin-based assessments into perioperative protocols may improve recovery trajectories.