Postoperative serum albumin drop predicts complications in primary total knee arthroplasty: a retrospective cohort study using XGBoost algorithm.

Key findings included: (1) Postoperative inflammation duality where CRP elevation increased risk (β=+0.692; OR = 2.00, 95%CI:1.54–2.58 per 10 mg/L increase), while paradoxical ESR reduction suggested compensatory mechanisms (β=−0.723); (2) Albumin dynamics dominated prediction (ΔAlb β=+0.537) with threshold-dependent effects—minimal risk at < 1.5 units versus exponential rise beyond this threshold; (3) Conventional predictors were displaced—diabetes retained marginal significance (β=+0.088, OR = 1.09) while ASA classification, age, and cardiac history were excluded; (4) Surgical paradoxes included preoperative hemoglobin increasing risk (β=+0.127), tourniquet time linearly accumulating risk (β=+0.101/10-min), and right-sided procedures showing protection (β=−0.056).

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