Predictive value of perioperative D-dimer to albumin ratio for postoperative serious medical complications and one-year mortality in elderly patients with hip fracture: a retrospective study

BACKGROUND: Elderly patients carry high risks of postoperative serious medical complications (PSMC) and mortality, but reliable perioperative predictive indicators remain limited. OBJECTIVE: To evaluate the predictive value of perioperative hematological markers for PSMC and 1-year mortality in elderly surgical patients. METHODS: A total of 590 patients aged 65-85 years were enrolled. Perioperative blood parameters were measured preoperatively and on postoperative days 1, 3, 5, 7. Patients were grouped by PSMC occurrence and 1-year survival status. ROC analysis was used to assess diagnostic performance. RESULTS: PSMC occurred in 58 patients (9.8%), and 89 patients (15.08%) died within 1 year. Perioperative red blood cells, hemoglobin, albumin, creatinine, procalcitonin, troponin, D-dimer, and D-dimer to albumin ratio (DAR) showed significant dynamic changes (all p < 0.01). The PSMC group had lower albumin and higher D-dimer and DAR than the non-PSMC group (all p < 0.01), with markedly higher 1-year mortality (86.21% vs. 7.33%, p < 0.001). Preoperative DAR showed the comparable predictive power for PSMC (AUC = 0.82), followed by D-dimer (AUC = 0.80) and albumin (AUC = 0.69). For 1-year mortality, D-dimer and DAR both had an AUC of 0.74, with DAR exhibiting higher sensitivity (85.39%). Elevated DAR was significantly associated with increased PSMC and mortality risks (both p < 0.001). Multivariate logistic regression showed high DAR was an independent risk factor for PSMC (OR = 26.82, p < 0.001) and 1-year mortality (OR = 21.75, p < 0.001). CONCLUSION: Perioperative DAR is a promising prognostic biomarker for PSMC and 1-year mortality in elderly surgical patients. High DAR indicates poor prognosis and may help identify high-risk individuals for targeted intervention.