Influencing factors for perioperative hidden blood loss and prognosis in elderly patients with intertrochanteric femoral fracture

To analyze the influencing factors for perioperative hidden blood loss in elderly patients with intertrochanteric femoral fracture and its impact on the prognosis.

A total of 128 elderly patients with intertrochanteric femoral fracture who underwent surgical treatment in Beijing Daxing District People's Hospital from May 2022 to April 2025 were enrolled as research subjects. The volume of perioperative hidden blood loss was investigated, and the difference in the loss volume was compared among patients with different clinical characteristics. Based on the average volume of the hidden blood loss during perioperative period, they were divided into a high blood loss group (n=77) and a low blood loss group (n=51). The postoperative prognosis indicators were compared between two groups of patients. SPSS 26.0 statistics was used for data analysis. Independent-samples t test or Chi-square test was performed depending on data type, and multivariate linear regression model was applied to analyze the the influencing factors for perioperative hidden blood loss in patients.

Among the 128 elderly patients with intertrochanteric femoral fracture, the average total volume of perioperative blood loss was (669.17±94.07) ml, of which the average volume of dominant blood loss was (175.70±35.43) ml and that of hidden blood loss was (493.47±87.65) ml. Multivariate linear regression analysis revealed that age ≥80 years (β=0.846, 95%CI 0.107–0.963; P<0.001), preoperative hypoproteinemia (β=0.519, 95%CI 0.043–0.889; P=0.029), Evans type ⅡB-Ⅲ (β=0.705, 95%CI 0.034–0.949; P<0.001), time from injury to surgery ≥48 h (β=0.421, 95%CI 0.063–0.735; P=0.012) were positively associated with perioperative hidden blood loss volume in elderly patients with intertrochanteric femoral fracture, while perioperative application of tranexamic acid (β=-0.319, 95%CI-0.669–-0.012; P<0.001) was negatively correlated with hidden blood loss volume. Comparison of prognosis between two groups showed that the incidence of nosocomial infection was significantly higher, and the time to ambulation with weight bearing and the fracture healing time were obviously longer in the high blood loss group than in the low blood loss group (all P<0.05).

The volume of hidden blood loss during perioperative period is quite high in elderlypatients with intertrochanteric femoral fracture, which is affected by multiple factors. This condition will increase the risk of nosocomial infection and prolong the fracture healing time, and should be paid more attention to in clinical practice.