Objective:

To evaluate the association between blood urea nitrogen to albumin ratio (BAR) and the risk of 1-year all-cause mortality after hip fracture (HF) surgery in elderly patients.

Approach:

• Study Design: A single center, retrospective cohort study including patients aged 60 years or older who underwent surgery for HF between May 2016 and December 2021.
• Data Collection: Clinical data and laboratory test results were obtained from electronic medical records, and survival status was confirmed through follow-up.
• Statistical Analysis: Logistic regression analysis was used to evaluate associations between BAR and 1-year mortality, with further analyses including RCS, AUC, sensitivity, and subgroup analyses.

Key Findings:

• A total of 521 patients were included, of whom 77 died within 1 year after hip fracture, corresponding to a mortality rate of 14.8%.
• In univariate analysis, several indicators including BAR were associated with mortality risk.
• After adjustments, only BAR remained significantly associated with mortality (OR = 1.13, 95% CI: 1.05–1.22, P < 0.01).
• The AUC for BAR was 0.67, indicating moderate predictive performance.

Interpretation:

Higher BAR early after admission is associated with increased risk of 1-year mortality in older patients with hip fracture.

Limitations:

• The study is retrospective and conducted at a single center, which may limit generalizability.
• The predictive performance of BAR was moderate and requires further validation in multicenter prospective studies.

Conclusion:

BAR may serve as a simple and low-cost auxiliary indicator for risk stratification in older patients after hip fracture surgery.