Impact of perioperative anemia and blood loss on mortality after proximal femoral fracture surgery

Introduction. Fractures of the proximal femur (PFF) represent an increasing health problem in the aging population, associated with a high risk of complications and mortality. Anemia, resulting from both trauma and surgical treatment, is an important prognostic factor; however, the impact of hematologic parameters on medium- and long-term outcomes remains unclear. This study aimed to evaluate the relationship between pre- and postoperative hemoglobin levels and intraoperative blood loss with mortality, operation time, surgical delay, and length of hospital stay in patients undergoing surgery for PFF. Materials and methods. This retrospective study included 124 patients who underwent surgical treatment for low-energy PFF. Data were obtained from hospital records and included age, sex, pre- and postoperative hemoglobin levels, time from admission to surgery, operation duration, length of hospitalization, and mortality at various follow-up periods. Patients were stratified by fracture type, treatment method, anemia severity, and intraoperative blood loss, estimated by hemoglobin drop. Results. The lowest mortality rates were observed in patients with normal hemoglobin at admission, while decreased hemoglobin was associated with higher short- and mid-term mortality. Patients with normal hemoglobin experienced shorter surgical delays and hospital stays. Greater intraoperative blood loss was linked to longer surgery duration in trochanteric fractures, but did not significantly affect hospitalization length. Conclusions. Low perioperative hemoglobin levels were associated with higher mortality in patients with proximal femur fractures. Patients with intertrochanteric fractures had a better prognosis than those with femoral neck fractures. Anemia was associated with longer waiting times for surgery and prolonged hospitalization. Intraoperative blood loss was linked to higher mid-term mortality. These findings underscore the need for further research on the impact of hematologic parameters on outcomes following proximal femur fractures.