Analysis of perioperative hidden blood loss and its risk factors in patients with intertrochanteric femoral fractures undergoing intramedullary fixation

CHENG Kai; KUANG Wen-zhong; ZHOU Chuan-you; SHU Jian; JIANG Shun

doi:10.13820/j.cnki.gdyx.20243625

Abstract：Objective To investigate the amount of perioperative hidden blood loss(HBL)and identify associat-ed risk factors in patients with intertrochanteric femoral fractures treated with intramedullary fixation.Methods A total of 136 patients with intertrochanteric femoral fractures who underwent intramedullary fixation between May 2022 and May 2024 were prospectively enrolled.The cohort included 60 males and 76 females,aged 35-92 years(mean age:65.4±7.2 years).HBL was estimated using the Gross formula,and patients were categorized into the HBL-positive group(HBL ≥470 mL,n=45)and HBL-negative group(HBL＜470 mL,n=91).Baseline characteristics(age,sex,BMI),comorbidities(hypertension,diabetes,preoperative anemia,hypoalbuminemia),time from injury to admission,anesthesia type,smoking history,modified Evans classification,preoperative use of vasoactive medications,fixation type[PFNA or Intertan],preoperative albumin and hemoglobin levels,and operative time were compared between groups.Multivariate logistic regression was conducted to identify risk factors for HBL positivity,and a predictive nomogram model was constructed and evaluated.Results The mean perioperative HBL among all patients was(685.7±142.0)mL.Compared to the HBL-negative group,patients in the HBL-positive group were older,had lower preoperative albumin levels,and had higher rates of hypertension and use of preoperative vasoactive medications(all P＜0.05).Multivariate logistic regression identified advanced age(OR=1.115,95％CI:1.047-1.189),hypertension(OR=2.602,95％CI:1.114-6.077),and preoperative use of vasoactive drugs(OR=2.652,95％CI:1.093-6.432)as independent risk factors for perioperative HBL.Preoperative albumin level was a protective factor(OR=0.879,95％CI:0.807-0.958).The nomogram model demonstrated good discrimination with a C-index of 0.785(95％CI:0.705-0.864),and the cal-ibration curve showed good agreement between predicted and observed outcomes.Conclusion Significant perioperative hidden blood loss occurs in patients with intertrochanteric femoral fractures undergoing intramedullary fixation.Age,hy-pertension,low preoperative albumin levels,and preoperative use of vasoactive medications are significant predictors.Spe-cial attention should be paid to elderly patients with comorbidities and those on long-term vasoactive therapies.