Predictive value of perioperative D-dimer to albumin ratio for postoperative serious medical complications and one-year mortality in elderly patients with hip fracture: a retrospective study

Elderly patients carry high risks of postoperative serious medical complications (PSMC) and mortality, but reliable perioperative predictive indicators remain limited. To evaluate the predictive value of perioperative hematological markers for PSMC and 1-year mortality in elderly surgical patients. A total of 590 patients aged 65–85 years were enrolled. Perioperative blood parameters were measured preoperatively and on postoperative days 1, 3, 5, 7. Patients were grouped by PSMC occurrence and 1-year survival status. ROC analysis was used to assess diagnostic performance. PSMC occurred in 58 patients (9.8%), and 89 patients (15.08%) died within 1 year. Perioperative red blood cells, hemoglobin, albumin, creatinine, procalcitonin, troponin, D-dimer, and D-dimer to albumin ratio (DAR) showed significant dynamic changes (all p < 0.01). The PSMC group had lower albumin and higher D-dimer and DAR than the non-PSMC group (all p < 0.01), with markedly higher 1-year mortality (86.21% vs. 7.33%, p < 0.001). Preoperative DAR showed the comparable predictive power for PSMC (AUC = 0.82), followed by D-dimer (AUC = 0.80) and albumin (AUC = 0.69). For 1-year mortality, D-dimer and DAR both had an AUC of 0.74, with DAR exhibiting higher sensitivity (85.39%). Elevated DAR was significantly associated with increased PSMC and mortality risks (both p < 0.001). Multivariate logistic regression showed high DAR was an independent risk factor for PSMC (OR = 26.82, p < 0.001) and 1-year mortality (OR = 21.75, p < 0.001). Perioperative DAR is a promising prognostic biomarker for PSMC and 1-year mortality in elderly surgical patients. High DAR indicates poor prognosis and may help identify high-risk individuals for targeted intervention.