Retrospective Cohort Study. To clarify the association between preoperative albumin status and mortality and morbidity in lumbar spine surgery. Hypoalbuminemia is a known marker of inflammation and is associated with frailty. Hypoalbuminemia is an identified risk factor for mortality following spine surgery for metastases, yet has not been well studied among spine surgical cohorts outside of metastatic cancer. We identified patients with preoperative serum albumin lab values who underwent lumbar spine surgery at a US public university health system between 2014 and 2021. Demographic, comorbidity, and mortality data were collected along with pre- and postoperative Oswestry Disability Index (ODI) scores. Any cause readmission within one year of surgery was recorded. Hypoalbuminemia was defined as <3.5 g/dL in serum. We examined Kaplan-Meier survival plots based on serum albumin. Multivariable regression models were used to identify the association between preoperative hypoalbuminemia with mortality, readmission and ODI, while controlling for age, sex, race, ethnicity, procedure and Charlson Comorbidity Index. Of 2,573 patients, 79 were identified as hypoalbuminemic. Hypoalbuminemic patients had significantly greater adjusted risk of mortality through 1 year (OR 10.2; 95% CI 3.1 - 33.5; P<0.001), and 7 years (HR 4.18; 95% CI 2.29 - 7.65; P<0.001). Hypoalbuminemic patients had ODI scores 13.5 points higher (95%CI 5.7 - 21.4; P<0.001) at baseline. Adjusted readmission rates were not different between groups through 1 year (OR 1.15; 0.5 - 2.62; P=0.75) or through full surveillance (HR 0.82; 95%CI 0.44 - 1.54; P=0.54). Preoperative hypoalbuminemia was strongly associated with postoperative mortality. Hypoalbuminemic patients did not have demonstrably worse outcomes in their functional disability beyond 6 months. Within the first 6 months following surgery, the hypoalbuminemic group improved at a similar rate to the normoalbuminemic group despite having greater preoperative disability. However, causal inference is limited in this retrospective study.