Preoperative Hypoalbuminemia and Mortality in Elective Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis

Objectives The prognostic value of preoperative serum albumin in patients undergoing elective aortic aneurysm repair remains uncertain. This systematic review and meta-analysis evaluated whether hypoalbuminemia predicts mortality in this population. Methods A comprehensive search of PubMed, Scopus, Cochrane Library, Ovid, and CENTRAL was conducted up to January 21, 2024. Eligible studies included patients undergoing elective aortic aneurysm repair, comparing mortality between those with hypoalbuminemia and those with normal serum albumin levels. The Quality in Prognosis Studies (QUIPS) tool was used to assess the risk of bias. Adjusted data were pooled to calculate odds ratios (ORs), and sensitivity analysis was performed. Results Four studies, comprising 14 136 patients were included. Meta-analysis demonstrated that hypoalbuminemia was significantly associated with increased odds of all-cause mortality (OR 3.18; 95% CI 1.78–5.67; P < 0.0001; I 2 = 88%). Subgroup analysis of endovascular procedures (EVAR, fenestrated or branched devices [F/B], and TEVAR) demonstrated a similar trend (OR 3.85; 95% CI 2.52–5.89; P < 0.00001; I 2 = 68%). Sensitivity analysis confirmed the validity of these findings. Conclusions Despite the limited number of available studies and evidence level, preoperative hypoalbuminemia appears to be an independent predictor of mortality following elective aortic aneurysm repair, with most available evidence derived from endovascular procedures. Given its association with comorbidity decompensation, inflammation, and malnutrition, serum albumin assessment may serve as a valuable preoperative risk stratification tool. Further high-quality research is needed to validate these findings and explore their clinical applicability.