Purpose: The aim of this systematic review and meta-analysis was to determine whether serum albumin level (<35mg/L) can predict mortality after proximal femoral fracture surgery in older adults. Methods: This review adhered to the guidelines outlined in the PRISMA statement. The electronic databases PubMed, EMBASE, Web of Science, and Cochrane were reviewed for studies. The risk of bias was assessed with the ROBINS-I tools. The following relevant data from each included study were extracted and reported by two independent reviewers: study design, sample size, follow-up, age, gender, mortality at last follow-up, odds ratio (OR). Results: In total, 2,009 studies were identified; 18 original articles satisfied both the inclusion and the exclusion criteria and were included in the final meta-analysis. At 1 month of follow up, among 15,284 patients, the OR was 1.20 (95% CI: 0.86–1.68) with an I-squared statistic of 98.3%. At 1 year of follow-up, among 2,281 patients, the OR was 1.88 (95% CI: 1.00–3.53) with an I-squared statistic of 20.5%. At long-term follow-up (beyond 3 years), among 283 patients, the OR was 5.58 (95% CI: 2.56–12.06) with an I-squared statistic of 0.0%. Evaluation of mortality hazard, among 283 patients, revealed a hazard ratio of was 1.04 (95% CI: 0.89–1.19) with an I-squared statistic of 40.2%. Conclusion: Over a follow-up period of more than three years, patients with low serum albumin levels have a 5.58 times higher mortality risk than those with normal levels. Additionally, at one year, patients with low serum albumin levels are 1.88 times more likely to die than those with normal levels. KEY WORDS: Proximal femoral fractures, pertrochanteric fractures, intertrochanteric fractures, hip fractures, albumin, mortality, nutritional state, odds ratio, hazard ratio.