Associations between preoperative hypoalbuminemia and clinical outcomes following total hip or knee arthroplasty: a systematic review and meta-analysis

Background: Preoperative hypoalbuminemia is common in patients undergoing total hip or knee arthroplasty (THA/TKA). While it has been linked with poorer postoperative outcomes, there remains a paucity of systematic reviews or meta-analyses dedicated to conducting a comprehensive evaluation of this issue. Methods: A comprehensive search was conducted across the PubMed, Embase, and Web of Science databases. Studies were selected and analyzed in adherence to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Data were extracted and subjected to meta-analysis or qualitative synthesis for outcomes. This meta-analysis was registered in the PROSPERO database (NO. CRD42024581376). Results: Fourteen studies involving 1,194,088 patients were included. Meta-analyses showed that preoperative hypoalbuminemia was associated with a greater risk of all-cause complications (OR: 2.89, 95% CI: 1.94-4.31), sepsis (OR: 2.54, 95% CI: 1.88-3.45), septic shock (OR: 3.44, 95% CI: 1.15-10.25), pneumonia (OR: 3.83, 95% CI: 3.14-4.67), urinary tract infection (OR: 1.59, 95% CI: 1.13-2.23), myocardial infarction (OR: 2.10, 95% CI: 1.47-2.98), superficial incisional infection (OR: 2.16, 95% CI: 1.56-3.00), periprosthetic joint infection (OR: 4.03, 95% CI: 2.15-7.53), wound dehiscence (OR: 1.68, 95% CI: 1.06-2.69), transfusion (OR: 1.84, 95% CI: 1.72-1.98), unplanned reoperation (OR: 1.60, 95% CI: 1.38-1.87), and mortality (OR: 7.14, 95% CI: 5.44-9.37). Conclusion: Preoperative hypoalbuminemia is associated with an increased risk of numerous types of complications, transfusion, unplanned reoperation, and mortality after THA or TKA. Therefore, presurgical protocols formulated to deal with these unfavorable clinical outcomes may pay particular attention to this specific patient group.