Screening

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.