Limited evidence supports preoperative assessment of serum levels of albumin and creatinine for risk assessment of hip fracture patients.

Management of Hip Fractures in the Elderly
Endorsed by: OTA, AGS, AAPM&R, ASBMR, USBJI, The Hip Society, AACE, ORA
Limited Evidence LIMITED EVIDENCE
Rationale
There was one moderate strength (Mosfeldt el al156) and four low strength prognostic studies assessing the effect of albumin levels on patient outcomes after hip fracture surgey (Burness et al154, Forminga et al155, Ozturk et al157 and Lieberman et al158). Low albumin levels had a statistically significant positive correlation with mortality in three studies (Burness et al154, Mosfeldt et al156, Ozturk et al157). Lieberman et al found that a 1 g/DL increase in serum albumin at discharge was associated with an 8.4% improvement on the Functional Independence Measure after rehabiliatation was complete. Finally, Forminga et al155 found that low albumin levels were associated with a higher risk of nosocomial infection and pressure ulcers. 

Three low strength prognostic studies assessed the effect of patient creatinine levels on outcomes after hip fracture surgery (Talsnes et al159, Bjorkelund et al160, Mosfeldt et al156). Talsnes et al159 found elevated creatinine levels on the 1 post-op day significantly increased the odds of mortality, but pre-op levels and day 4 post-op levels were not significant predictors of death. Finally Bjorkelund et al160 did not find creatinine levels of > 100 g/L to be signicantly associated with post-op confusion, in-hospital complications or length of hospitals stay beyond 10 days. 

Risks and Harms of Implementing this Recommendation
There are no risks associated with this recommendation. 

Future Research
Further studies are needed to evaluate the importance of pre-op assessment to risk stratify and optimize elderly patients with hip fractures. Measurement of the serum calcium, albumin, 25-hydoxyvitamin D, and creatinine levels may reveal secondary causes of osteoporosis (e.g. hyperparathyroidism, malignancy, vitamin D deficiency or chronic kidney disease) and could guide use of calcium, vitamin D, or nutritional supplements which may improve outcomes. 

 
  1. (150) Bischoff-Ferrari HA, Dawson-Hughes B, Platz A et al. Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: a randomized controlled trial. Arch Intern Med 2010;170(9):813-820.
  2. (152) Harwood RH, Sahota O, Gaynor K, Masud T, Hosking DJ. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study. Age Ageing 2004;33(1):45-51.
  3. (153) Chapuy MC, Arlot ME, Duboeuf F et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992;327(23):1637-1642.