Preoperative Serum Albumin as an Independent Risk Factor for Prolonged Wound Drainage Following Proximal Femoral Nail Osteosynthesis in Older Hip Fracture Patients: A Retrospective Cohort Study.

BACKGROUND

Prolonged wound drainage (PWD), defined as serous or serosanguinous discharge from the surgical incision exceeding 2 × 2 cm on the dressing and extending beyond 48 hours postoperatively, is a significant complication following hip fracture surgery. Data regarding the specific effect of preoperative albumin levels on PWD in older hip fracture patients treated with proximal femoral nail (PFN) osteosynthesis are limited.

MATERIALS AND

METHODS

This retrospective cohort study analyzed 39 patients aged 65 years and older who underwent PFN osteosynthesis for hip fractures. Patients were stratified based on postoperative wound drainage status: PWD (n = 11) and non-PWD (n = 28). Multivariate logistic regression analysis was performed to identify independent risk factors for PWD.

RESULTS

Preoperative serum albumin level was significantly lower in the PWD group (27.18 ± 4.19 g/L) compared to the non-PWD group (34.00 ± 4.97 g/L; P < .001). In univariate analysis, American Society of Anesthesiologists score (3.36 ± 0.81 vs 2.71 ± 0.66; P = .0134) and operation duration (118.64 ± 18.72 vs 99.82 ± 26.58; P = .019) were also significantly higher in the PWD group. Age, sex, body mass index, and fracture type were not significantly different between groups. In multivariate analysis, serum albumin level was identified as the sole independent risk factor for PWD (odds ratio: 0.749, 95% confidence interval: 0.589-0.952; P = .018).

CONCLUSION

Preoperative serum albumin level is an independent and powerful risk factor for the development of PWD in older patients undergoing hip fracture surgery treated with PFN osteosynthesis. Early preoperative assessment of serum albumin and targeted nutritional optimization may be a modifiable and cost-effective intervention to reduce the incidence of PWD.