Prophylactic percutaneous intra-aortic balloon occlusion reduces blood loss during anterior acetabular fracture surgery: a propensity score-matched study

Intra-aortic balloon occlusion (IABO) is used to control pelvic hemorrhage and has recently been adapted to elective surgery to limit intraoperative blood loss. Its role in acetabular fracture fixation, particularly via anterior approaches, remains unclear. This study evaluated whether prophylactic percutaneous IABO is associated with reduced blood loss during anterior open reduction and internal fixation (ORIF) of acetabular fractures, using propensity score matching (PSM) to minimize selection bias. We conducted a retrospective cohort study including 80 consecutive adult patients who underwent anterior ORIF for acetabular fractures between 2013 and 2024. Twenty-four patients received prophylactic percutaneous IABO, and 56 served as controls. One-to-one PSM (caliper 0.2 SD of the logit) was performed on demographics, fracture characteristics, and surgical factors, yielding 20 matched pairs. Outcomes included intraoperative blood loss (IBL; primary), total blood loss (TBL; gross formula), operative time, transfusion, reduction quality, perioperative complications, and IABO-related parameters. IABO was associated with significantly lower blood loss both before and after matching. In matched pairs, median IBL was 525 g versus 1070 g in controls (p = 0.004), representing a 51% reduction, while TBL was 601 g versus 921 g (p = 0.003), corresponding to a 35% reduction. Operative time, reduction quality, infection, and venous thromboembolism did not differ between groups. In the IABO cohort, the median insertion time was 13 min and balloon inflation duration was 43 min. No IABO-related complications were observed in this cohort. Prophylactic percutaneous IABO was associated with a significant reduction in intraoperative and total blood loss during anterior acetabular fracture fixation. Given its minimal additional setup time, it may serve as a practical adjunct in selected high-risk anterior approaches. Further prospective studies are warranted to confirm these findings.