Lower preoperative albumin levels significantly increase the risk of anastomotic leakage in digestive tract surgery, impacting surgical decision-making.

• Patients with lower albumin levels face a 2.67-fold higher risk of leakage (odds ratio 2.67; 95% CI 1.85-3.87; p <0.01).
• An optimal albumin threshold of 3.75 g/dl was identified for effective risk stratification.

This underscores the importance of nutritional assessment and support prior to surgery to improve patient safety.