To address shortcomings in prior literature and to explore the clinical utility of preoperative serum albumin among patients at a population level, we evaluated the association between hypoalbuminemia in the 30-day preoperative period and the occurrence of adverse surgical outcomes among a large multi-disciplinary cohort generated from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. This evidence concerns the gene ALB and Hypoalbuminemia.