Preoperative Hypoalbuminemia and Adverse Outcomes in Total Hip Arthroplasty: A Retrospective Study

Objective To evaluate the association between preoperative hypoalbuminemia and postoperative inflammatory parameters, blood loss, and adverse complications in patients undergoing primary total hip arthroplasty (THA). Methods A retrospective study was conducted on 128 patients who underwent primary THA at Henan Provincial Hospital of Traditional Chinese Medicine from January 2022 to March 2025. Patients were divided into a control group (serum albumin ≥ 35 g/L, n = 105) and a hypoalbuminemia group (serum albumin < 35 g/L, n = 23) based on preoperative serum albumin levels. Preoperative and perioperative parameters, including inflammatory markers (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune-inflammation index [SII]), total blood loss (TBL), hidden blood loss (HBL), complications, and readmission rates, were compared. Results No significant differences were observed between groups in age, sex, body mass index (BMI), comorbidities, surgical indications, American Society of Anesthesiologists (ASA) classification, anesthesia type, operative time, length of hospital stay, preoperative NLR, PLR, SII, transfusion rate, or ICU admission (P > 0.05). Compared to the control group, the hypoalbuminemia group had significantly higher postoperative NLR, PLR, SII, TBL, HBL, total complications, and readmission rates. Pearson correlation analysis showed preoperative albumin was negatively correlated with TBL (r=-0.209, P = 0.018) and HBL (r=-0.304, P = 0.001). Conclusion Preoperative hypoalbuminemia is associated with increased postoperative inflammation, blood loss, and complications in THA patients, indicating that routine albumin screening may identify at-risk patients. Prospective studies are warranted to evaluate nutritional optimization strategies