Introduction: For several years, human albumin was administered to patients to intervene on oncotic pressure and intravascular volume (1) until an article published in Cochrane in 1998 signaled to the scientific community that its administration could be dangerous in critically ill patients compared to use of crystalloids. In recent years, in which costs are dominating, influencing clinical choices, Hospitals are changing "register" and protocols. Our San Pio di Benevento Hospitals for example, has recently tightened its belt by adopting a stringent protocol adhering to the dictates of the AIFA note 15 (Italian Minister of Health) and to international guidelines. The Protocol obviously has in its premises the purpose of improving the appropriateness of the clinical use of Human Albumin as a priority of the national and regional health system as well as an objective of the S.S.N. Materials and Method: To this end, for cognitive purposes, in our company we retrospectively analyzed the data relating to a cohort of patients over 75 after major orthopedic surgery followed in the year 2020-2021. Results: The association of serum hypoalbuminemia - hyponutrition and IV supplementary treatment (OR = 0.03) as the first choice was to be classified as a very strong association and in general the therapeutic choice extremely different from recent company indications (Chi - box 9.899, p0.0017, OR 0.03). Conclusions: all Italian hospitals have regulated the use and request of Human Albumin in accordance with the International and National Guidelines and AIFA Note 15 (12). The indications are exhaustively shared and explained and the necessary dose dose is calculated by applying a dedicated formula that we here report. The message is That all recent protocols have to limit improper use in the absence of certainties, if only for the certainly high cost of the drug. However, pending new and stronger evidence, compared to the past Albumin will continue to be considered as an additional weapon in selected cases promoting always a Lean Managemene based approach.
